w4 - Ax of APD (tests and categories) Flashcards
1
Q
How are APD TB, APD test, APD models, and APD categories different?
A
- APD test battery: going through a series of tests
- APD test: a single test of APD
- APD models: a framework that has been designed
- APD categories: sublevels within a framework (tests within each category to target certain things)
2
Q
In clinics you follow a ____
A
test battery
3
Q
Why don’t we follow models in clinic?
A
- It is not feasible to complete an entire model within an Ax time (not enough time), can make a wrong assumption with a complex model, also, these are just “suggested” models.
- Many people choose a couple of tests from a specific model to make it more feasible (not including all of the suggested tests in a TB).
4
Q
What are the 11 considerations for an APD diagnostic assessment?
A
- taking a comprehensive case history by interview
- completing a checklist/questionnaires through interview
- observing the case behaviour (how they respond to questions or directions)
- gathering additional information from a multidisciplinary team
- controlling over confounding factors (medication, attention, fatigue)
- conducting APD tests in a sound treated booth
- no single APD TB is suitable for every suspected individual
- the TB should be chosen based on: case hx, checklists, parent/teacher questionnaires, multidisciplinary team
- TB should include both verbal and nonverbal tests
- APD tests should have psychometric properties reported (sensitivity, specificty, reliability, vailidty)
- Have knowledge of what a TB evaluates
5
Q
What information should you find out about in case history?
A
- auditory and communication difficulties
- family history
- general and medical history
- developmental milestones
- comorbid conditions
- medications
- social development/behaviour
- education/work history
6
Q
Why should you take case hx, checklists, and questionnaires through itnerview?
A
- Follow up questions
- Observe the whole family (parent and child interaction)
- Can help make decisions regarding the TB
7
Q
Who is part of the APD multidisciplinary team?
A
- slps
- psychologists/psychiatrists
- family drs, pediatricians, otologists
- occupational therapists, optometrits
- teachers
8
Q
Explain controlling over confounding factors
a) medication
b) attention and fatigue
A
medication: taking regular prescribed medications to reduce the impact of confounding factors (ADHD, depression) - complete APD testing under medication
attention & fatigue: considering break periods during a test or between tests to prevent the fatigue impact
9
Q
What happens if you dont take confounding factors into account?
A
can affect the results
10
Q
How long is a childs attention span?
A
Need to offer breaks (especially for children)
- Add 2 minutes to the age and this is the maximum limit the child has to complete a test (attention span)
- Ex) 6 year old child = 8 min attention span
11
Q
Why do you need to conduct APD tests in a sound treated booth?
A
This is important because: it maximizes control (no distractions), most tests include BGN (we need control over stimulus level)
12
Q
Why do we need to include nonverbal Ax in the TB?
A
Help us to check if there is something wrong related to the entire auditory neural network
13
Q
What are the 4 psychometric properties?
A
1) sensitivity
2) specificity
3) validity
4) reliability
14
Q
What is sensitivity?
A
detecting disorder when present
15
Q
what is specificity?
A
not detecting disorder when absent
16
Q
what is reliability?
A
the consistency of a measure (whether the results can be reproduced under the same conditions)
17
Q
What is validity?
A
- the accuracy of a measure (whether the test measures what it is supposed to measure)
- measuring auditory processing skills in the context of APD
18
Q
Why do we need high levels of reliability and validity?
A
- We don’t want to say its APD if it isn’t
- Need to be smart in deciding what test to use
If a test isn’t reliable, if you do the test twice, results may not add up (if you get the same result twice, you can assume the test is reliable)
19
Q
Depending on the test, it can evaluate what?
A
multiple levels and the integrity of the CANS
- left ear/brain
- right ear/brain
- brainstem
- interhemispheric regions
20
Q
What are the 4 models of the APD TB?
A
1) the minimal TB or medical model
2) the bellis and ferre model
3) the buffalo model
4) the spoken language processing (slp) model
21
Q
What is an important matter that all of the models acknowledge?
A
mitigating the impact of fatigue and low attention on test results
22
Q
Explain the 7 steps of the minimal test battery (MTB) model
A
1) pure tone audiometry: to evaluate the integrity of the peripheral hearing system
2) immittance audiometry: to evaluate the status of the middle ear and aid in diagnosing auditory neuropathy
3) otoacoustic emissions: used to diagnose inner ear problems
4) ABR and MLR tests: to test the neural synchrony and integrity of the auditory brainstem and the cortex
5) performance-intensity functions for word recognition ability
6) a dichotic task: using words digits, or sentences to assess communication between the brain hemispheres
7) the duration pattern test & temporal gap detection test: to evaluate temporal processing aspects of APD
23
Q
What two tests make up the MTB TB?
A
A dichotic task, duration pattern test/temporal gap detection test
24
Q
What are the 4 concerns surrounding the MTB model?
A
- A medical framework (does not address the behavioural and educational concerns; a very audiological view of APD)
- Doesn’t use interviews (focuses on the medical side of things, not functional)
- Mostly diagnostic tests focused on lesions in the auditory system
- Focuses on physical damage
25
What is the only model that utilizes electrophys Axs?
MTB model
26
In relation to the MTB model, what is the performance intensity (PI) function OR PI-phonetically balanced (PB) function?
- It refers to the relationship between speech perception scores and increasing levels of sound presentation
- It measures how well a person can understand speech (usually words from a phonetically balanced word list) by increasing the speech presentation level
- The scores typically improve as the loudness increases until they reach a plateau, where further volume increases no longer result in better scores
- Its especially useful in diagnosing SNHL or retro-cochlear disorder
27
Why do many audiologists use the MTB model?
Because it is a very short TB
28
What is the 4 aims of the bellis/ferre model?
To provide comprehensive understanding of APD by testing/collecting information n about:
- Auditory processing skills
- Language skills
- Learning abilities
- Cognitive function
29
Compared to the medical framework, the bellis/ferre model considers assessing what?
Non-auditory factors.
30
The bellis/ferre model consists of…
3 APD profiles
2 secondary APD profiles (subcategories)
31
Does the bellis/ferre model recommend certain tests to use?
No, it is up to you
32
- What are the 3 APD profiles identified from the bellis/ferre model?
o 1) auditory decoding deficit
o 2) prosodic deficit
o 3) integration deficit
33
- Bellis/ferre model: an auditory decoding deficit is characterized by what 4 things?
o 1) poor performance in the right ear vs the left ear on specific speech tests (difficulty in the left brain and processing/decoding speech and language info)
o 2) poor phonemic representations, sound discrimination, and blending skills
o 3) difficulty in reading, vocabulary, and spelling
o 4) auditory fatigue
34
- What is the primary site of dysfunction for an auditory decoding deficit (bellis/ferre model)
o The left PAC
35
- Bellis/ferre model: a prosodic deficit is characterized by what 4 things?
o 1) poor performance in the left ear on dichotic tests (difficulty in the right brain and processing prosodic information, music, numbers)
o 2) difficulty perceiving and recogniszing nonverbal information (tonal patterns, singing ability, voicing patterns)
o 3) weakness in social communication
o 4) poor results in visual spatial tasks
36
- Bellis/ferre model: an integration deficit is characterized by what 4 things?
o 1) poor performance in the left ear on dichotic tests
o 2) poor performance in nonverbal tests
o 3) difficulty in interhemispheric skills, requiring the coordination of the 2 hemispheres (drawing, dancing, multitasking)
o 4) poor sound localization abilities
37
- What is the main difference between prosodic and integration deficits?
o For integration, the corpus callosum is essential
38
- What are the two secondary APD profiles from the bellis/ferre model?
o 1) auditory associative deficit
o 2) output-organization deficit
39
a) What is an auditory associative deficit (bellis/ferre model)
b) poor results in...
o Characterized by miscommunication between PAC and SAC (from what we receive in PAC and what we process in SAC)
o Poor results in tests of word recognition, dichotic, and receptive language (vocabulary, semantics, and syntax)
40
- The PAC is the ____, and the SAC is the ___
o Core, belt/parabelt
41
a) What is an output-organization deficit (bellis/ferre model)
b) difficulties with...
o Person performs well on simple tasks, but struggles with complex tasks
o Ex) sound blending (retaining and blending several sounds), sequencing, planning, and/or fine motor tasks
42
- Can combinations of profiles occurs in the bellis/ferre model?
yes
43
- What 3 tests does the buffalo model consist of?
o 1) staggered spondaic word test (SSW)
o 2) phonemic synthesis test (PST)
3) speech in noise test
44
- Buffalo model: explain the SSW
o SSW is the core of the buffalo model
o The staggered presentation challenges auditory processing
45
- Buffalo model: what do poor results in PST suggest?
o The decoding subtype of APD
46
- Buffalo model: what do poor results in SIN tests suggest?
o Tolerance-fading memory (TFM) subtype of APD (the ability to remember information for a short period of time
47
a) Buffalo model: explain TFM
b) also show difficulties in...
o It is proposed that TFM is a secondary deficit to APD
o Inability to retain auditory information, affecting the amount of information a person can handle at one time
o Additional to SIN difficulty, individuals often show:
Impatience, and easily get over-stimulated
Poor reading comprehension
Handwriting difficulty
48
- By just using 3 Ax, you get more information with the ____ model rather than the ____ model
o Buffalo, bellis/ferre (the bellis/ferre doesn’t even list the Ax to use)
49
- What are the 4 APD subtypes described in the buffalo model?
o 1) decoding
o 2) tolerance fading memory
o 3) integration
o 4) organization
50
- How does the buffalo model explain the subtype of decoding? Poor results in…
o Phonemic processing (in identifying, manipulating, and remembering phonemes)
o Oral reading, word accuracy, spelling skills, and proeessing rapid speech stimuli
51
- How is the buffalo subtype of decoding similar to the BF model?
o Same as auditory decoding deficit profile
52
a) How does the buffalo model explain the subtype of tolerance fading memory? Poor results in…
b) commonly seen in?
o Short term auditory memory
o Processing auditory information in the precesnce of noise
o Inhibiting responses (impulsivity)
o Commonly observed in those with ADHD
53
- Is the TFM subtype included in the BF model?
No
54
How long is STM?
o Typically less than 20 sec (but case by case; inter subject variability)
55
How does the buffalo model explain the subtype of integration? Poor results in (3)…
o Transferring interhemispheric information
o Severe reading and spelling problems
o Integrating visual and auditory information
56
- How is the buffalo subtype of integration similar to the BF model?
o Same as the integration deficit profile
57
a) How does the buffalo model explain the subtype of organization? Poor results in…
b) commonly seen in?
o Organizing, planning, and sequencing tasks
o Reversals (repeating stimuli out of sequence)
o Commonly observed in individuals with attention disorders
58
- How is the buffalo subtype of organization similar to the BF model?
o Same as the output-organization deficit profile
59
- The buffalo model provides ____ quantitative and qualitative indicators
34
60
- Buffalo model: what are quantitative indicators based on?
o Number of errors in 3 tests
61
- Buffalo model: what are qualitative indicators based on?
o Behavioural observations during testing (Checklists, questionnaires, case hx)
o Additional analyses within and/or between tests
62
- Explain the spoken-language processing model
o Very heavily focused on speech and language
o The model views auditory processing as part of speech and language processing
o APD is a component of a broader speech and language disorder
63
- The SLPM assesses what 8 things?
o Lexical decoding
o Fading memory
o Auditory linguistic integration
o Sequencing
o Short term memory span
o Prosodic perception
o Attention
o Phonologic problems
64
- Why do audiologists not use the SLPM model in clinical practice?
o To time consuming
o Need to have the tests with available normative data
o Completely focused on speech and language
o Some audiologists find it difficult to relate the prevalence of this model to APD
65
- Current models of APD TB only rely on ____, not ____
o Behavioural auditory processing tests, not electrophysiologic tests
66
- What are the benefits of including electrophysiologic tests in the APD TB (4)?
o Speech ABR
o Provide information about neural synchrony and sound representation in auditory pathways
o Assist in testing patients with a lack of cooperation in behavioural tests
o Assist in monitoring improvements following intervention
67
- Explain speech ABR
o Speech/complex ABR uses stimuli such as /b/ “bbb” as stimuli instead of a click or pulse tone
o Speech ABR may be a game changer because when we use speech for recording an ABR< it gives us a lot of information
68
- What are the challenges/limitations of including electrophysiologic tests in the APD TB?
o Lack of availability in all clinical settings
o Require expertise and experience for testing and interpretation
o Impose additional costs
o Their normal results do not rule out APD
o Do not provide functional information: the ability to process and utilize auditory information
69
- What are the 5 categories of an APD diagnostic test? What do each assess?
o Dichotic speech tests (assess binaural separation and integration)
o Monaural low-redundancy speech tests (assess monaural separation/closure)
o Auditory temporal processing and patterning tests (assesses temporal resolution, nonspeech sound discrimination, temporal ordering)
o Binaural interaction tests (assesses binaural interaction)
o Auditory discrimination tests (assesses speech and/or nonspeech discrimination
70
- What is dichotic listening?
o DL involved presenting different stimuli simultaneously to each ear
71
- DL tests have variations based on what?
o Stimuli and linguistic load (monosyllabic words to short sentences)
Task difficulty/requirements
72
- What are the 2 AP skills assesses by DL tests?
o Binaural integration (reporting stimuli from both ears)
Basic DDT
o Binaural separation (only reporting stimuli from the target ear and ignoring competing signals from the other ear)
Can still do the DDT, but ask them to only repeat what they hear from the right ear (directed test)
73
- What are DL tests sensitive to?
The brainstem, cortical, and/or callosal lesions
74
- What are 3 commonly used DL tests?
o The dichotic digit test (DDT)
o The staggered spondaic word (SSW) test
o The competing sentences test (CST)
These get more difficult farther down the list
75
- DDT age
o > 7 years
76
- DDT: test structure
o Composed of naturally spoken digits from 1-10, excluding 7
o Includes 20-digit pairs for a total of 40 test items per ear
o Two different digits are presented to each ear simultaneously
o Conducted under earphones at 50 dB SL
77
- DDT instruction
o Two numbers are presented per ear (a 4back test) and the person should repeat all the numbers heard in any order. Guessing is encouraged.
78
- DDT: scoring method
o Each ear score is compared with age-appropriate norms
79
- SSW: aim
o To detect possible lesions in the brainstem or cortical areas
80
- SSW: stimulus presentation
o Dichotic under headphones in a quiet testing environment
o The first syllable of the first word and the second syllable of the second word are presented individually to the RE and LE. The other 2 syllables are overlapped and presented simultaneously
o This is known as cardinal numbers
81
- SSW: age
o 11 and up
82
- SSW: stimuli
o Spondaic words: 2 syllable words with equal stress on both syllables
o Consisting of 40 pairs of spondaic words (20 pairs for each ear)
83
- SSW: scoring and interpretation
o Quantifying the percentage of correctly identified syllables for 8 cardinal numbers
o Quantifying some specific types of errors such as omission or substitution of syllables
84
- Why is the SSW such a complex task?
o This is a complex test (gives you a lot of information on monaural information, binaural information, information at the level of the brainstem, etc)
o This covers a bunch of information by just performing one test (multiple tests in one)
85
- Ipsilateral-contralateral competing sentence test (IC CST): age
o 11 and up
86
- ICCST: stimulus presentation
o Monaural/dichotic under headphones in a quiet testing environment
o sentences
87
- ICCST: testing protocols
o 1) presenting both target signal (TS) and competing signal (CS) to one ear and requiring TS to be repeated
o 2) presenting TS and CS dichotically and requiring TS to be repeated
o 3) presenting TS and CS dichotically and requiring both TS and CS to be repeated
88
- ICCST: SNR
o -10 or -15 dB (this is a very tough test and shows why its important to look at APD TB case by case)
89
- ICCST is mostly a test of ____, not APD
o Attention
90
- Monaural low-redundancy speech tests: aim
o To test auditory closure: the ability to fill in missing components of a degraded signal and recognize the message in its entirety (someone with APD struggles to fill in the missing parts of speech)
91
- MLRST: 3 commonly used tests
o 1) the low pass filtered speech test
o 2) the time compressed speech test
o 3) the synthetic sentence identification test with ipsilateral competing message
92
- Low pass filtered speech test: aim
o To assess speech perception ability when high frequency components are removed, leading to reduced clarity and intelligibility
93
- LPFST: stimulus presentation
o Monaural under headphones/speakers in a quiet testing environment
94
- LPFST: stimuli
o Low pass filtered monosyllabic words or sentences
o The filtering ranges from mild to severe
95
- LPFST: scoring and interpretation
o Percentage of correctly identified words or sentences
o The results are compared with age appropriate normative data
96
- Time compressed speech test: aim
o To test the ability to understand rapid speech rates by distorting/degrading the speech signal
97
- TCST: stimulus presentation
o Monaural under headphones in a quiet testing environment
98
- TCST: stimuli
o Words or sentences
o They are digitally time-compressed between mild and severe (30 to 70%, 70% is the hardest) leading to increased speech rates
99
- TCST: scoring and interpretation
o Percentage of correctly identified words or sentences
o The results are compared with age appropriate normative data
100
- Why is TCST difficult for those with APD?
o They don’t have that background information (they never had the chance to learn how to fill in these blanks)
101
- Explain the synthetic sentence identification test with ipsilateral competing message (SSI-ICM)
o The SSI-ICM uses synthetically constructed sentences that are grammatically correct, but lack meaningful content (ex: small boat with a picture has become)
o These sentences are presented to the listener along with a competing message in the same ear (ipsilateral)
102
- Who is the SSI-ICM test difficult for?
o Very difficult for a person with ESL, APD, and ADHD (they could never complete this test)
103
- SSI-ICM: aiM
o To measure the ability to correctly identify the target sentence, while ignoring the competing signal
o Assessing auditory processing abilities in challenging listening environments
104
- SSI-ICM: stimulus presentation
o Monaural under headphones/speakers in a quiet testing environment
105
- SSI-ICM: age
o 11 and up
106
- SSI-ICM: stimuli
o The message signal consists of 10 synthetic sentences spoken by a single talker
o The competition signal is a male talker reading a passage
o The message to competition (MCRs) ratios: -20 to +10 dB per set of 10 sentences
107
- SSI-ICM: scoring and interpretation
o The MCR at which the listener can repeat back 50% of target sentences correctly
o The results are compared with age appropriate normative data
108
What are auditory temporal processing and patterning tests (ATPPT) assessing?
o To test auditory timing and pattern processing using non speech stimuli
o Testing temporal resolution and temporal ordering
o Gives us information about auditory timing and pattern processing
109
- ATPPT: why important
o Necessary for discriminating rapidly changing spectro temporal features in speech sounds
o Essential for perceiving prosodic aspects of speech (rhythm, stress, intonation)
110
- ATPPT: 3 widely used tests (what does each test assess)
o 1) gaps in noise (GIN) to assess temporal resolution
o 2) frequency pattern test (FPT) to assess temporal ordering
o 3) duration pattern test (DPT) to assess temporal pordering
111
- ATPPT: 2 additional tests
o Auditory fusion test
o Backward and forward masking test
112
- What are the 6 rapidly changing spectro-temporal features in speech sounds?
o 1) format transitions: rapid shifts in vocal tract rsonances (formats) between consonants and vowels
o 2) voice onset time: the time between the release of a stop consonant and the onset of voicing
o 3) stop consonant bursts: a brief burst of noise when the closure of a stop consonant is released
o 4) fricative noise: turbulent noise created by airflow through a narror constriction in fricatives
o 5) pitch contours in prosody: rapid change in pitch that convey intonation or emotion
o 6) dipthongs: vowel sounds that involve a rapid transition between 2 vowel qualities
113
- GIN: aim
o To detect deficits in temporal resolution perception
114
- GIN: stimulus presentation
o Monaural under headphones in a quiet testing environment
115
- GIN: age
o 6 and up
116
- GIN: stimuli
o A series of noise stimuli with brief gaps (2 and 20 ms) inserted at irregular intervals (constant noise presented at MCL)
o The individual responds by pressing a button or giving a verbal response
117
- GIN: scoring and interpretation
o The percentage of correct gap detections
o The results are compared with age appropriate normative data
118
- FPT: aim
o To assess the ability to discriminate changes in frequency/pitch
119
- FPT: stimulus presentation
o Monaural under headphones in a quiet testing environment
120
- FPT: age
o 8 and up
121
- FPT: stimuli
o A series of tone stimuli with varying frequency patterns (880 and 1122 Hz)
o 2 frequencies x 3 presentations = 6 different patterns
o The person is instructed to respond verbally or manually
122
- FPT: scoring and interpretation
o The percentage of correctly identified frequency patterns
o The results are compared with age appropriate normative data
123
- DPT: aim
o To assess the ability to discriminate changes in temporal patterns
124
- DPT: stimulus presentation
o Monaural under headphones in a quiet testing environment
125
- DPT: age
o 11 and up
126
- DPT: stimuli
o A series of tone stimuli with varying duration patterns (500 or 250 ms)
o 2 durations x 3 presentations = 6 different patterns
o The person is instructed to respond verbally or manually
127
- DPT: scoring and interpretation
o The percentage of correctly identified duration patterns
o The results are compared with age appropriate normative data
