Spa Final Flashcards
(146 cards)
1
Q
Does unaided AAC include?
- Sign Language
- Facial Expressions
- Gestures
A
Yes
2
Q
What is AAC?
A
An approach to facilitate communication/communication
intervention for individuals with little to no functional speech output
or those with complex communication needs.
AAC is any communication modality that is not speech output.
3
Q
Regular AAC includes what?
A
Sign language
Use of pictures, symbols, and/or gestures
Speech-generating devices
4
Q
Does the need for AAC increase with age?
A
Yes
5
Q
Which of these options are developmental disorders?
- Cerebral Palsy “CP”
- Autism Spectrum Disorder “ASD”
- Apraxia of Speech
- Genetic Disorders
- Intellectual Disabilities
- Amyotrophic Lateral Sclerosis “ALS”
A
Answer: 1, 2, 3, 4, 5
6
Q
What are the Acquired Disorders?
A
Amyotrophic Lateral Sclerosis
(ALS)
* Multiple Sclerosis (MS)
* Traumatic Brain Injury (TBI)
* Stroke (CVA)
* Acute illness
* Requiring intubation or
tracheostomy and/or
ventilator support
* Laryngectomy
* Glossectomy
7
Q
Augmentative Communication
A
Use of a mode of communication, in addition to the current mode,
to improve the ability to convey a message.
8
Q
Assistive Technology
A
Use of technology to complete tasks that would not be possible
due to disability.
* Wheelchairs
* Computer hardware and software
9
Q
The choice of which AAC is utilized is based on an individual’s
needs, function/abilities, and the environment where
communication is taking place.
* Many people utilize both unaided and aided AAC
communication – this is considered to be multimodal
communication. True/False
A
True
10
Q
Intelligibility
A
The degree by which speech (natural or that generated by a device) can be
understood by the communication partner(s).
11
Q
Comprehensive communication
A
How well an AAC user’s communication is understood when it is combined with
the context.
* Linguistic context/topic of the conversation
* Physical environment
* Gestures
12
Q
Efficiency with use of the AAC system
A
The time and rate that an individual can communicate with an AAC system and
the time required to interpret the message
13
Q
Unaided AAC
A
Does not utilize a device
* “No-tech” – no technical support is required
* May include:
* Sign language
* Gestures
* Eye gaze
* Facial expressions
* Tone of voice
* Can enhance existing communication ability.
* Requires the physical/motor function to produce the required nonverbal
movements.
14
Q
Aided AAC
A
Utilizes an external device for communication.
* These devices have two categories:
* Low-technology AAC
* High-technology AAC
* For both categories, the uses access the device directly or
indirectly.
15
Q
Low-Tech AAC
A
Does not require a power source.
* Could be a primary means of communication or a supplemental/back-
up system.
* Communication boards or books
* With letters, words, pictures or symbol systems.
* Limitation: Utilized for requesting; does not easily allow for a variety
of communication functions.
16
Q
High-Tech AAC
A
There is a wide selection of high-tech AAC devices from a variety of
companies.
* For high-tech AAC, the user accesses the computer/device to
generate speech output,
* A speech generating device (SGD)
* Speech output can be:
* Digitized – a human voice stored on a computer
* Voice banking
* Synthesized – computer generated
* Provide more interactive communication (not just requesting)
* Expensive
Design of the system can be:
* Dedicated
* Created exclusively for speech output
* Open
* A multifunctional device
* Provides speech output AND has the functions of a regular
computer
17
Q
AAC Assessment
A
- What is the cause of the individual’s communication disorder?
* 2. How does the person communicate currently?
* 3. Is the person able to communicate effectively using natural
speech?
* If not, what is the best way for this individual to communicate?
* 4. What are the individual’s communication needs?
* 5. What kind of AAC would be the most appropriate to match the
individual’s cognitive, physical and linguistic strengths?
* 6. Can the AAC system be modified in the future to meet the
individual’s changing needs?
18
Q
ASHA, 2018 – The outcome of an assessment is to recommend an
AAC system and design treatment that will assist the individual in
achieving the most effective interactive communication possible.
* Evaluation often occurs over the course of several sessions.
* Various unaided and aided approaches can be trialed.
True/False
A
True
19
Q
How is an AAC Assessment Different?
A
Evaluation batteries may need to be adapted and extra support may be
required for completion.
* AAC assessments typically take a great deal of time to complete.
* AAC assessments are ongoing.
* A team of professionals may be involved.
* OT
* PT
* Optometry/Ophthalmology
* Tends to focus on communication competence, rather than specific
language areas/skills.
* Includes assessment of physical and sensory abilities
20
Q
A successful assessment for AAC results in:
A
Matching the AAC approach to an individual’s:
* Wants
* Needs
* Capabilities
21
Q
Treatment of AAC
A
Promoting success with the chosen AAC device/approach.
* Device/system training with:
* The client
* Family members
* Caregivers
* Treatment should take place in the natural environment to promote
generalization.
* Move to promote generalization AND to use the AAC system to target broader
communication goals (development of language, literacy and social
interaction).
22
Q
Treatment Models AAC
A
- Participation Model
* 2. Communicative Competency Model
23
Q
AAC Treatment: Participation Model
A
A functional intervention that is based on the person’s
participation requirements, particularly in relation to
her/his peers of the same age that do not require AAC.
AAC Treatment: Participation Model
The goal of treatment is for the user of AAC to
communicate as their peers do. Treatment stresses
communication opportunity and communication access,
both of which must be addressed for individuals to
participate fully in their lives.
An important feature of the Participation Model is the
creation of a participation inventory that identifies the
person’s communication patterns and needs.
24
Q
AAC Treatment: Communicative
Competency Model
A
Defined as the state of being functionally adequate in
daily communication and of having sufficient
knowledge, judgment, and skills to communicate
effectively in daily life.
25
To achieve communicative competency in the use of
AAC, the individual needs to develop knowledge,
judgment and skills in four domains:
Operational
Strategic
Linguistic
Social
True/False
True
26
History of AAC – Where did it start and where is it going?
Use of AAC began in the 1950’s.
* Multidisciplinary assessment/intervention
* Communication boards
* In 1960, an early electronic AAC device was developed
* Activation of a typewriter with a sip-and-puff switch was utilized.
* Sip-and-puff switch development – based on use of a whistle in hospitals.
* In the 1970’s there was hesitation by professionals to utilize AAC with
individuals thought to have potential to develop verbalizations/speech.
* In the early 1970’s Shirley McNaughton began use of Blisssymbolics (the Bliss
symbol system)
* Goal was to develop a universal picture language system with a specific grammar to
order and combine symbols.
27
where is it going?
AAC advanced during the 1970’s & 1980’s.
* Gregg Vanderheiden (a student of another AAC leader, David Yoder),
credited with coining the term augmentative communication, further
developed the technology.
* Advances in the past 20 years have been amazing and are ongoing.
* Check out the website links provided in our Module
28
Cultural Considerations and AAC
The selection of unaided and aided forms of AAC, as well as the choice of
symbols, and manner of interaction needs to be considered from the
cultural perspective of the client.
Having a clear understanding of family members’ values, beliefs, child-
rearing practices, parent-child interaction styles, interpersonal styles,
attitudes and behaviors can help professionals remove barriers to culturally
sensitive practice.
Considerations for bilingual clients (assessment in both language) with
device set-up appropriate for language use.
29
Current Research in AAC
AAC use in the area of Autism Spectrum Disorder (ASD)
* Approximately 1/3rd of children with ASD who do not develop functional
speech and language could benefit from AAC.
* Some of these individuals were not considered for AAC use due to expressive
language.
* Evidence continues to grow that demonstrates that use of an AAC is beneficial
to augment communication skills.
30
Visual Display and Tracking
Use of AAC devices require visual skills.
* Our understanding and the technology for use with users with visual
issues continues to improve.
* Screen colors
* Eye gaze technology
31
The communication board makes it easy for patients and clients to make more than just requests. True/False
False
32
Use of an AAC device should only be used on patients with autism spectrum disorder as a last resort because it can negatively impact expressive language development. True/False
false
33
To use an AAC device the client must have some visual skill or function. True/False
True
34
AAC should be used in a clinical environment rather than the patients to avoid distraction. True/False
False
35
AAC means to intervene with a speech-generating device. True/False
False
36
AAC Assessment involves which of these options?
1. frequently occurs over several sessions
2. Can include trial varieties of aided and unaided communication approaches
3. focuses on communication competence
4. Often includes a multidisciplinary team
Answer: All options
37
What model is used to help AAC users communicate as their peers?
The participation model
38
What high-tech AAC allows for the functions of speech output, and the functions of a regular computer?
Open
39
An individual who uses an AAC device can select symbols directly and indirectly. True/False
True
40
Training for an AAC device should include everyone. True/False
True
41
A communication board is a what?
A low tech AAC
42
Hearing Anatomy
The anatomical components of hearing (audition) have two
components:
* 1. Peripheral Auditory System
* 2. Central Auditory System
43
The Peripheral Auditory System
Begins with the outer ear and ends at the auditory nerve
1 2
44
The Central Auditory System
From the auditory nerve all the way to where
the final processing of information occurs,
within the auditory cortex (Heschl’s gyrus in
the temporal lobe of the brain).
45
Outer Ear
The auricle (AKA: the pinna)
* Our visible “ear”
* Comprised of elastic cartilage
* Components:
* Helix – the outer rim
* Tragus – in front of the external canal
* Lobule – the ear lobe
* Functions:
* 1. Protects the middle ear
* 2. Assists in localizing sounds
* Minimizes front-back confusion
* Ear movements in animals
* Cupping of a hand behind the ear
The external auditory canal (meatus)
* 2.5 cm in length
* Extends from the auricle to the eardrum
* Outer 1/3s - made of elastic cartilage
* Inner 2/3s – carved into the temporal bone
* This canal is lined with skin and hair
* Also contains ceruminous glands
* Secrete cerumen – ear wax
* Prevents drying of the canal
* Deters intruders
* Function: Directs sound toward the eardrum
* The shape also increases the loudness of high-pitched/frequency sounds
46
Middle Ear
A small air-filled space
* Located within the temporal bone
* Structures:
* Tympanic membrane (ear drum)
* Three bones (tiny)
* Malleus (hammer)
* Incus (anvil)
* Stapes (stirrup)
* Two muscles
* Eustachian tube
Tympanic Membrane
* Amplifies
Ossicular Chain
* Amplifies
Eustachian Tube
* Equalises
47
The Tympanic Membrane "Middle Ear"
A tightly stretched membrane that spans across the ear
canal.
* The sound waves that reach the tympanic membrane set it
into vibration.
48
The Ossicles "Middle Ear"
Referred to as the ossicle chain
* The malleus is in contact with the tympanic membrane.
* Vibration of the tympanic membrane moves the malleus.
* Next, the incus moves.
* Lastly, the stapes moves.
* The stapes is in contact with the oval window of the cochlea (the
inner ear) – coming up next!
49
Muscles of the Middle Ear
In contact with the ossicle chain.
* 1. Tensor tympani
* Extends from the front wall of the middle ear and attaches to the malleus.
* 2. Stapedius
* Extends from the back wall of the middle ear and attaches to the stapes.
* Both muscles provide protection for the inner ear.
* These muscles stiffen the ossicular chain when a very loud noise occurs to
restrict movement; this dampens the transmission of sound.
* The contraction of these muscles in response to loud sounds is
involuntary.
* Called the “acoustic reflex”
50
The Eustachian Tube "Middle Ear"
Courses from the middle ear downward, toward the upper pharynx.
* Has an opening in the upper pharynx.
* Functions to drain the middle ear and to equalize middle ear pressure with
atmospheric pressure.
* At rest, the eustachian tube is closed; it opens with changes in pressure.
* “Ears popping”
* In younger children, the eustachian tube is short and is situated more
horizontally.
* This results in poor drainage of any middle ear fluid which results in a greater risk of
middle ear infections in young children.
* Middle ear infections – otitis media
51
Inner Ear
Housed within the temporal bone of the
skull.
* Fluid-filled space
* Made-up of two organs
* 1. Cochlea
* Hearing
* 2. Vestibular apparatus/system
* Made up of the semicircular
canals
* Balance
52
Cochlea "Inner Ear"
Has the appearance of a snail shell
* Cochlea is Greek for “snail shell”
* In humans, the cochlea has about 2.75 turns.
* The largest turn, near the stapes, the basal end.
* The smallest turn, the apical end
Comprised of three
compartments
* The organ of Corti – located
within the cochlea
* Has 4 rows of hair cells
* The hair cells span the entire length
of the cochlea (from the basal end to
the apical end)
* There are approximately 20,000 total
hair cells
* At the top of each hair cell, there is a
very tiny fiber from the auditory
nerve that is attached.
* Hair cells sense the sounds from
transferred from the middle ear and
they transmit the signal to the brain.
53
The organ of Corti
Organized by pitch/frequency
* Tonotopic organization
* Different areas of the cochlea
respond to different frequencies.
* The basal end of the cochlea
vibrates most with high
frequency tones.
* The apical end of the cochlea
vibrates most with low
frequency tones.
54
Central Auditory System
The electrical (neural) energy generated in the
cochlea is carried by the auditory nerve.
* The auditory nerve travels to the brainstem
(specifically the medulla of the brainstem)
* At the level of the brainstem, most of the nerve
fibers cross over to the other side of the
brainstem.
The nerve fibers course upward, through the
brainstem.
* Nerve fibers exit the brainstem and course to the
temporal lobe of the brain.
* The auditory cortex (Heschl’s gyrus)
Sound is processed within the auditory cortex (Heschl’s gyrus) within
the temporal lobe.
* Since the nerves cross over to the other side, within the brainstem,
sound entering the right ear will be processed on the left side of the
brain (the left hemisphere) and sound entering the left ear will be
processed on the right side of the brain (the right hemisphere).
55
Hearing – Energy Transformation
The human hearing mechanism transforms sound energy
* The vibration of molecules in the air (or another medium) is
called acoustic energy
* This energy is transformed several (three) more times within
the auditory system.
56
Summary of energy transfer within the ear
Vibration of air molecules / Acoustic energy is directed into the ear via
the pinna (auricle).
2. The acoustic vibration travels through the ear canal (auditory canal or
auditory meatus) and reaches the tympanic membrane which then
vibrates. This changes the acoustic energy into mechanical energy.
3. The mechanical energy reaches the oval window at the beginning of the
inner ear (the cochlea). This moves the fluid within the cochlea and
converts the mechanical energy into hydraulic energy.
4. The hydraulic energy moves the hair cells/nerve endings which converts
the energy to electrochemical (neural) energy. These neural impulses
are sent to the brain (via nerves).
57
Human Hearing
We hear sounds that range from 20 Hertz (Hz) to
20,000 Hz.
* The frequency range that we hear.
* Think about sounds that we cannot hear – a dog whistle
* It is above 20,000 Hz
58
Sound
Results from a disturbance of molecules (air particles) – typically caused
by vibration (think of a speaker or the string on a guitar).
59
Sound wave
When air particles are disturbed, the vibration creates a sound wave.
* One back and forth motion of an air particle is called a cycle.
60
Frequency
Refers to how quickly the particles are vibrating
* Frequency is measured in Hertz (Hz).
* Perceived as pitch – low-pitch / high-pitch
61
Pure tone
A sound with only one frequency
62
Complex sound
A sound that contains ore than one
frequency
63
Noise
sounds without a vibratory pattern
64
Intensity
Refers to the configuration of a sound wave
* The height of the wave is the maximum point of
disturbance.
* The intensity of a sound refers to loudness.
* Loudness is measured in decibels (dB).
* One decibel is the smallest difference in sound
intensity that the human ear can detect.
65
Deafness
minimal hearing or complete loss of
hearing.
66
Congenital deafness
deafness at birth.
67
Adventitious deafness
deafness that occurs after
birth.
68
Hard of hearing
hearing loss ranging from mild to
profound
69
Three Types of Hearing Loss
*
1. Conductive
* 2. Sensorineural
* 3. Mixed (Conductive & Sensorineural
70
Conductive Hearing Loss
An issue with sound transmission in the outer or middle ear
* Many issues that result in conductive hearing loss can be
treated with medical or surgical intervention.
71
Disorders of the Outer Ear (Conductive)
Atresia
* Absence of normal opening of the outer ear.
* Congenital absence of the external auditory
canal.
* Obstruction of the ear canal
* Cerumen impaction
* Q-tips should not be utilized!
* Otitis externa (swimmer’s ear)
* Usually caused by a bacterial infection of the thin
skin that lines the ear canal.
72
Disorders of the Middle Ear (Conductive)
Perforation of the tympanic membrane (ear drum)
* Limits vibration (and thus limits transmission of sound) of the
tympanic membrane, thus negatively impacting upon activation
of the ossicle chain.
* Otitis media
* Middle ear infection
* More common in children than adults (**remember the
positioning of the eustachian tube in children).
* Otitis media with effusion
* Includes fluid within the middle ear
Otosclerosis
* Abnormal bone growth within the ossicle chain.
* Interferes with movement and thus transmission of
sound.
* Treatment can be surgical
* Involves partial or complete removal of the stapes
* The cause is unknown – there does appear to be a genetic
component.
73
Sensorineural Hearing Loss
Caused by damage to the inner ear.
* Damage to the inner ear may also cause balance disorders/dizziness.
* Causes:
* Prenatal issues
* Viral infection during pregnancy
* Meningitis
* Especially bacterial meningitis (less common) – can result in damage to the cochlea
* Ototoxic drugs
* Includes some antibiotics and chemotherapy agents
* Meniere’s disease
* Impacts both balance and hearing
* Presbycusis
* Noise-induced hearing loss
74
Presbycusis
Gradual hearing loss due to the effects of aging.
* Deterioration in audition begins at about age 18 years.
* Hair cells within the cochlea become damaged due to use –
especially those near the basal end (recall that those hair cells are
responsible for the hearing of high-frequencies).
* Between the age of 65 – 75 years, 35% of adults have hearing loss.
* After age 75 years, hearing loss occurs in 50% of people
75
Noise-Induced Hearing Loss
* Similar to presbycusis, however it occurs at a much earlier age.
* Due to exposure to excessive noise.
* Likely going to rise due to use of ear buds/headphones
* Preventable with proper precautions and hearing protection.
* Audiologists play a role in hearing loss prevention programs.
76
Disorders of the Central Auditory System
Any damage or impairment in the structures/system from the
auditory nerve to the brain.
* Called a “retrocochlear” pathology – damage beyond the cochlea.
* Acoustic neuroma
* A benign brain tumor that grows along the auditory nerve.
77
Aspects of the Configuration of Hearing Loss
The level of impairment at different frequencies
* One ear (unilateral) versus both ears (bilateral)
* Symmetrical hearing loss versus asymmetrical hearing loss
* Progressive hearing loss versus fluctuating hearing loss
78
Other Hearing Disorders
Tinnitus
* “Ringing” in the ears
* Can be associated with hearing loss
* Treated by Otolaryngology
* Auditory Processing Disorder
* Impaired ability to process auditory information
* Hearing acuity is normal
* Intelligence is normal
* Testing is completed by an Audiologist who specializes in this area
79
Pure-Tone Audiometry
Recall our discussion about pure tones earlier – a sound with only one
frequency.
* The frequency range tested is from 250 Hz – 8,000 Hz (the frequency range
for conversational speech).
* Testing is completed with an audiometer in a sound booth.
* Two types of pure-tone assessment:
* 1. Air conduction – headphones over the outer ear
* Tests hearing of sounds that travel through the air
* 2. Bone conduction – a bone vibrator placed behind the ear on the mastoid process of
the temporal bone
* Bypasses the outer and middle ear systems
* Normal bone conduction with abnormal air conduction indicates a disorder of the
outer or middle ear.
* **See Figure 12-15 on page 290
80
The way we hear ourselves
“That isn’t what I sound like.”
* When we hear someone else speaking, we hear them through
what is called air conduction.
* Sound that travels through the air
* When we speak, we hear our own voice through air conduction
AND bone conduction.
* The sound travels through the bones of the skull, directly to
the inner ear as well as the sound that travels through the air.
* The answer: the recording of your own speech/voice really
is how you sound to others.
81
Audiogram
Audiologists utilize an audiogram to depict the findings of a pure-tone
hearing assessment.
* Red – Right ear
* Blue – Left ear
82
immittance testing
Evaluates the function of the tympanic membrane and the middle
ear.
* This doesn’t require active participation by the patient/client.
* The test is completed with a tympanometry
* A probe is placed within the ear canal
83
Acoustic Reflex
Tests the involuntary contraction of the stapedius muscle (within the
middle ear).
* A probe is inserted into the ear that presents a high-intensity sound.
* Completed with the tympanometry probe
84
Electrophysiologic Testing
Does not require active participation by the client/patient.
* Includes:
* Otoacoustic emissions (OAE)
* Evaluates inner ear function
* Auditory brainstem response (ABR)
* Measures brain wave activity – the brain’s response to sound
* These assessments can be utilized to test hearing function in
infants.
85
A Note
In some cases, tests of hearing that do not require patient/client
participation are helpful/necessary.
* Malingering
* Deliberate dishonesty about a hearing loss (faking)
* Usually done for financial gain
* A malingerer – term for the person who malingers
86
Cultural Considerations
Middle ear infection (otitis media) occurs more frequently in indigenous
populations.
* Attributed to:
* Potential anatomical predispositions
* Physical environment
* Limited medical attention (health inequities)
* Age related hearing loss (presbycusis)
* Most common in white males
* Melanin-A pigment, found in higher levels in blacks may protect cochlear hair cells.
* Male versus female
* Males are 5 times more likely than females to develop presbycusis.
* Biological difference
* Occupations with high noise levels
87
Cultural Consideration - Social Impact
Hearing loss can be isolating
* Individuals may be less likely to participate in cultural and
social events
* Individuals over 65 years of age with hearing loss are less
likely to participate in volunteer work within their
community.
* Individuals 70 years of age and older with hearing loss are
more likely to experience depression (than their peers
without hearing loss).
88
Current Research
Musical Training
* May reduce the effect of aging on the auditory system.
* Musical performance may maintain neurons.
* Musicians have a “younger” brain than non-musicians on imaging.
* Tinnitus
* Effects 2 million Americans
* Recent research indicates that the cause of tinnitus may be in the brain (in the areas
that process information from the ears).
* Individuals with tinnitus have greater brain activity in these areas.
* Vestibular Disorders
* Development of prosthetic devices (implantable and non-implantable) to send signals
to the CNS regarding movement
* Not currently available – in development
89
A person with conductive and sensorineural hearing loss has mixed hearing loss. True/False
True
90
Abnormal bone growth in the middle ear creates sensorineural hearing loss is called otosclerosis. True/False
False
91
Mieneres disease is caused by ototoxic medications. True/False
False
92
Noise exposure typically results in conductive hearing loss. True/False
False
93
The auditory nerve from the right ear carries the neural signal to the right temporal lobe of the brain. True/False
False
94
We hear are voices as we speak through air and bone conduction. True/False
True
95
People with an auditory processing disorder have impaired hearing acuity for higher frequencies. True/False
False
96
In young children, the eustachian tube is positioned diagonally to prevent infection of the middle ear in children. True/False
False
97
What are the structures of the inner ear?
Vestibular apparatus "semicircular canals etc"/ Cochlea
98
We measure loudness in what?
decibels
99
Pure tone is a what?
A sound with only one frequency
100
The hair cells of the corti, found on the basal end of the cochlea vibrate the most intense when experiencing what?
High Frequencies
101
The middle ear turns acoustic energy into mechanical energy. True/False
True
102
The term perceived as pitch referring to to the fastness of air movement is?
Frequency
103
What is required by an Audiologist during an immittance test?
Evaluation of the tympanic membrane, and middle ear
Requires no patient participation
completed with tymponometer
104
Humans hear sound ranges from what?
We hear sounds that range from 20 Hertz (Hz) to
20,000 Hz.
105
Acoustic Reflex
Tests the involuntary contraction of the stapedius muscle (within the
middle ear).
* A probe is inserted into the ear that presents a high intensity sound.
* Completed with the tympanometry probe
106
What hearing assessment is used evaluate air traveling through air
Air conduction – headphones over the outer ear
* Tests hearing of sounds that travel through the air
107
Components of the outer ear
1. Helix
2. External Auditory Canal "meatus"
3. Lobule
4. Tangus
108
Inner ear functions
Hearing/Balance
109
Atresia
Outer Ear
110
Perforation of the tympanic membrane
middle ear
111
Otitis Media
Middle ear
112
Osteoschlerosis
Middle ear
113
Presbycusis
Inner ear
114
Noise-induced hearing loss
Inner Ear
115
Acoustic Neuroma
Central Auditory
116
What is Auditory / Aural Rehabilitation
Intervention with techniques for individuals with hearing
impairment to improve communication function in the areas
of:
* Listening
* Speaking
117
Rehabilitation Versus Habilitation
Aural Rehabilitation
* Provided to individuals who had normal hearing function earlier in life and
then developed a hearing impairment.
* Intervention focuses on improving communication to compensate for reduced hearing
acuity.
* Aural Habilitation
* Individuals who have reduced hearing acuity at birth.
* Intervention also focuses on strategies to compensate for reduced hearing acuity.
* **Intervention – Creating an individualized program to maximize
function in activities of daily living.
118
Hard of hearing
An impairment of hearing
* Can range from mild to severe
119
Deafness
An impairment of hearing that results in minimal to no
functional hearing.
120
How/where did auditory rehabilitation begin?
Resulted in response to World War II veterans.
* Soldiers who served experienced noise-induced hearing loss.
* Prior to this, there were no programs available to address hearing loss for
adults with previous functional hearing.
* Military hospitals developed auditory rehabilitation programs.
* Specialists included:
* Speech-language pathologists
* Psychologists
* Physicians
* Deaf educators
* This need resulted in the creation of the field of Audiology.
121
Field of Audiology
From 1950 – 1980 the field focused on diagnosis of hearing loss;
there was less attention on intervention for rehabilitation of hearing
loss.
* During that timespan, it was considered unethical for an audiologist to be
involved in hearing aid sales.
* Rehabilitation was typically provided by salespeople, not hearing
professionals.
* In 1978, ASHA began permitting audiologists to dispense hearing aids.
* Currently, audiologists provide hearing evaluation (comprehensive
diagnostics) and rehabilitation.
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Hearing Devices
Function to increase the loudness of sound.
* Early amplification (prior to the 20th century) was provided by
reducing noise and directing the message directly to the ear.
* Ear trumpet (Figure 13-1)
* Technology has increased in the past century including:
* Electricity
* Work of Alexander Graham Bell (telephone technology)
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Hearing Aids
Comprised of a microphone, amplifier and a speaker.
* The first electronic hearing aid was released in about 1900.
* Initially the devices were large and were external, table-top, devices.
* Improvement in function and size (with smaller devices) was made
possible with advances in technology; this included transistors and
miniature batteries.
* In the 1990’s, hearing aid technology advanced from analog to digital.
* Current hearing technology interfaces with blue tooth.
124
Treatment Approaches
Surgery
* Hearing devices
* Assistive listening devices
* Auditory implants
125
Surgery
Otolaryngology (Otology)
* Addresses particular issues with the tympanic membrane
and the middle ear.
* 1. Myringotomy
* 2. Tympanoplasty
1. Surgery
* Myringotomy
* Completed to drain fluid accumulation within the middle ear space.
* Relieves pressure by allowing the fluid to drain.
* Typically, as part of this surgical procedure, ventilation tubes are placed
within the incision.
* This provides a way for fluid to continue draining.
* These tubes typically “fall out” after about 9 months as the tympanic
membrane closes at the site of the incision.
* Tympanoplasty
* Repair of perforation of the tympanic membrane alone or with surgical
intervention involving the ossicles.
126
Hearing Devices
Hearing Aids
* Behind-the-ear (BTE) aid
* Durable (good for use with children)
* Provides a high level of amplification
* In-the-ear (ITE) aid
* Custom made to fit within the outer ear
* Utilized for mild to severe hearing losses
* Not good for severe-to-profound hearing loss
* Requires good finger/hand dexterity
* Small controls
2. Hearing Devices
* Hearing Aids
* In-the-canal (ITC) aids
* Smaller than the ITE aid
* Fits partly within the ear canal
* Good for mild to moderate hearing loss
* Easier for phone use
* Completely-in-the-canal (CIC) aids
* Very small (battery is small, too)
* Sits close to the tympanic membrane
* Improves sound quality
* Body-Worn aids
* Early hearing aids were body-worn
* The design has improved
* Provide a high level of amplification
* Used for profound hearing loss
* Simple to operate with large switches
* Lower cost
127
Active Listening Devices
Primary purpose is to separate background noise from the sounds of
speech.
* Improves the signal to noise ratio
* Includes:
* A telecoil
* Sound-field amplification
* FM systems in classrooms
* Amplifies the speakers voice through loud-speakers
* Captioning
* In person
* Auto captions – the recording must be set up for captions
128
Auditory Implants
Can potentially be utilized when a hearing aid alone is not enough.
* Do not amplify sound like a hearing aid does.
* Compensate for non-functioning components of the auditory system.
* Includes:
* Bone anchored hearing aids
* Cochlear implants
* Auditory brainstem implant
* Middle ear implant
Bone-Anchored Hearing Aid (BAHA)
* Works by taking the sound from the outside and
transmitting it to the inner ear through the temporal bone.
Cochlear Implant
* Works by transmitting signals sent through the skull to an
array of electrodes situated along different regions of the
cochlea.
Auditory Brainstem Implant
* Device specifically designed to bypass the cochlea and the
auditory nerve to transmit sound directly to the brainstem.
Middle Ear Implant
* Designed to convert sound into mechanical vibrations that
are then delivered to the inner ear.
* Newest type of implant
129
Treatment Approaches – Speech & Language
Intervention for speech & language abnormalities that frequently
occur with hearing impairment.
* The earlier in development that a hearing impairment occurs, and the
more severe the hearing loss is, the more of an impact it will have on
speech and language development/function.
* There are “expected” disorders that result from hearing loss.
Speech and language abnormalities that may
accompany a hearing impairment including deficits in
the areas of:
Phonology
Voice
Language
Speaking rate
130
Speech & Language Characteristics
Phonology, Semantics, Syntax, Pragmatics, Voice, Sapregsfedmental Features
131
Rehabilitation Approaches
Speech Reading
* Cued Speech
* Oral/Aural Approach
* Manual Approach
* SimCom
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Speech Reading
AKA: Lip reading
* Also includes use of speaker’s facial expression,
gestures and hand movements.
* Not all sounds are visible
* 30% of English consonants and vowels are visible
* Must “fill in the gaps” to read what is spoken.
* Speech reading is usually combined with use of
other assistive technology.
133
Cued Speech
Designed to assist with reduced visibility in
speech reading.
* The hand shapes/signals indicate the sound
being produced.
* Limited as it is not used by all, in everyday
communication exchanges.
134
Oral / Aural approach
Oral – the mouth
* Aural – the ear
* This rehabilitation approach targets improving both speech and
hearing functions.
* Targets speech articulation, hearing aids and speech reading.
* Goal – to communicate via spoken language in a hearing world.
* Use of biofeedback can be utilized to target intelligible speech
production.
* Nasometer
* Visipitch
135
Manual Approach
Movement of the hands, body, face and head to communicate.
* Use of the visual mode to communicate.
* Includes:
* Finger spelling
* Sign Language
* American Sign Language (ASL)
* Utilized in: the US, Canada and parts of Mexico
* Has its own grammar and syntax (including word order).
136
Simultaneous Communication Approach
SimCom
* Promotes the use of all modes of communication for
hearing impaired individuals.
* Focuses on effective communication.
* Utilized in some educational settings for deaf children.
* Learn language and develop communication skills to
function in the hearing world.
137
Cultural Considerations
Culture
* “A system of values, attitudes, beliefs, and learned behaviors shared
by a population.” (pg. 322)
* “Culture is shaped by factors such as geographic location, education,
age and sex.” (pg. 322)
* Hearing ability can also be a feature of an individual’s culture.
* There are two perspectives (opposing) on culture & deafness.
* Medical model versus the cultural model
138
Medical Model
Views deafness as a disability and an illness.
* This definition implies that intervention such as surgery and or use
of a device (like a hearing aid or a cochlear implant) can “fix” this
“problem”
* Discourages separation from the hearing world
* Encourages the individual to develop oral skills.
* Discourages use of sign language, alone.
139
Deaf Culture/Community
Views deafness as a difference, not an illness or disorder.
* As such, no surgery is required.
* Within the deaf community there is a great amount of activity,
socialization and accomplishment.
* Terms:
* deaf – “d” – Refers to an individual who has profound hearing loss and utilizes
oral communication as their first language.
* Deaf – “D” – Refers to an individual who has profound hearing loss but does
not view it as a disability. Would typically utilize sign language as their
primary means of communication.
140
Deaf Education
Founded by Laurent Clerc – An accomplished deaf academic from France – the
“father of deaf education”.
* Thomas Hopkins Gallaudet – An American who collaborated with Clerc to
found the first school for the deaf in the US, the American School for the Deaf
(in CT).
* Gallaudet University, in Washington, DC, is named for him. (See pg. 277)
* Established in 1864, it was the first university designed to accommodate
deaf and heard of hearing students.
* Hearing students can attend the graduate programs in speech-
language pathology and audiology
141
Current Research
Cognitive Function
* In the elderly population, individuals with severe hearing loss
experience more significant declines in cognitive ability known to be
associated with aging.
* Additionally, recent study findings demonstrated that cognitive
declines are less evident in elderly individuals who wear a hearing aid
(regularly) versus those with hearing impairment that do not.
Hearing Aid Microphone Design
* Improvements would lead to even better function of an amplification
device, to promote better communication in noisy environments.
* Currently, work is being completed to investigate how a tiny fly, the
Ormia Ochracea, hears.
* It can locate the sound of crickets by their singing.
* Models of the fly’s ear are being created to design to allow for better sound
location and amplification.
Auditory Training
* Beyond fitting of a hearing aid!
* Research shows that auditory training, beyond just fitting a hearing
aid, results in improved overall communication function and
satisfaction with a hearing aid.
* This training targets listening skills in various activities.
* Training activities include interactive activities with apps and computer
programs.
142
What areas of language are impaired by hearing disorders?
Phonology
Voice
Language
Speaking Rate
143
Myringotomy and Tympanoplasty address issues in the middle ear. True/False
True
144
Body Warn Aids
Early hearing aids were body-worn
* The design has improved
* Provide a high level of amplification
* Used for profound hearing loss
* Simple to operate with large switches
* Lower cost
145
Habilitation
Intervention for individuals with decreased hearing acuity at the time of birth.
146
Treatment options for hearing disorders include
surgery, hearing devices, assistive listening devices, and auditory implants.
