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What are two general objectives of the aurditory training process?
- 1) learning to maximize the use of auditory and other related cues available for perception of speech.
- 2) Adjustment and orientation to facilitate the optimm use of amplification, including CI's and tactile devices.
What is the main goal of the auditory training process?
Achieve maximum communication potential by developing the auditory sensory channel to its fullest.
What are the pediatric procedures for early efforts to auditory training? (prelingual deafness)
- 1) development of awareness of sound.
- 2) development of gross discriminations.
- 3) development of broad discriminations among simple speech patterns.
- 4) development of finer discriminations for speech.
What are adult procedures of auditory training process?
- 1) focus on reeducating a skill diminished as a consequence of hearing impairment.
- 2) need to develop a critical listening attitude that involves active participation in perception of frequently missed phonemes.
- 3) goal is to develop faster processing and recognition of the signal.
What is the significance of assessing auditory skills?
- This should be completed before, during, and at the conclusion to evaluate and document progress.
- - important for
- 1)need of training
- 2) for documentation and for comparison of pre/post therapy process
- 3) identify areas of need for future training
What are 4 methods of auditory training?
- 1) Analytic
- 2) Synthetic
- 3) Pragmatic
- 4) Eclectic
What is analytic auditory training?
Breaking speech into smaller components (phoneme, syllable) and incorporate these separaely into auditory training exercise
What is synthetic auditory training?
Global approach to speech perception, stressing the use of clues derived from the syntax and context of a spoken message to derive understanding (words, phrases and sentences)
What is pragmatic auditory training?
- training listener to control communication variable such as the level of speech, the SNR, and the context or complexity of the message.
- -Uses repair stategies
What is eclectic auditory training?
Combining most or all of the strategies of auditory training
What are some visual stimuli that play important roles in how we process speech?
- 1) facial expression
- 2) hand gestures
- 3) speaker's mouth movements
- 4) physical environment
Define manual communication
(signing) relies on the visual system to communicate via special signs and symbols made with the hands and is received and interpreted visually
How do the HI use visual information of oral communication?
- the listener uses visual cues by observing the speaker's mouth, facial expressions and hand movements.
Why use the term speechreading instead of lipreading?
The listener must look at more than just the mouth to recieve the message.
What are the four factors that affect speechreading?
- 1) Speaker
- 2) Signal code
- 3) Environment
- 4) Speechreader
How does the speaker affect speechreading?
- - There are differences among speakers which have great effects on speechreading.
- - Familiarity of speaker increases speechreading performance.
- - Appropriate facial expressions, common gestures, and correct positioning (45o angle) facilitate better communication.
What is the normal rate of phonemes per second and how many can the eye record per second?
What might the speaker do that would inhibit comprehension?
- - Extremely exagerate or slow speech
- - Chewing, yawning, hands near the mouth and wearing sunglasses.
What are some keys to allow better speechreading?
- -Speak slightly slower to normal rate with precise, not exaggerated articulation.
- -Use appropriate facial expression and gestures
- *Ex. Shrug with "I don't know."
What are 3 factors to improve speechreading?
- 1) speaker awearness of the speechreader
- 2) speechreader needs to guide and lead the topic (Spchrdr needs to be assertive)
- 3) use residual hearing in combination with speechreading. (use of Fm Sys's, pocket talkers etc.)
What are the DO NOTs when talking to a speechreader?
- 1) Do not slow speech.
- 2) Do not speak excessively loud.
- 3) Do not overemphasize articulation.
- 4) Do not break down sentences into single word utterances.
Define repair strategies.
- 1) Asking the speaker to repeat when you don't understand (not huh or what).
- 2) Paraphrasing ( saying it in a different way)
- 3) Asking for key words.
- 4) Breakdown a story into a couple of key sentences.
Define distinctive features.
Unique characterisitics of a given phoneme that distinguish one phoneme from another.
- A group of phonemes in which each looks alike when spoken.
- -Ex: /k/, /g/, and -ing
What percent of words in conversational speech ar indistinguishable visually?
Words that look alike when spoken but sound different.
What percentage of phonemes are not readily visible?
What is an important speechreading factor to remember when speaking in connected discourse?
Always need to be most "normal" as possible.
Why is topical constraint important for speechreading?
- This will limit conversation to a specific topic, which governs the vocab that is appropriate to describe the topic.
- * when violating topic constraint give verbal warning. (not to change the subject but....)
What are the environmental speechreading factors?
- 1) Distance
- 2) Lighting
- 3) Viewing Angle
- 4) Contextual and situational information
What are the best distance conditions for speechreading?
- -Optimal when the speaker is about 5 feet from the speechreader
- -Performance desreases for every 5 feet but does not drop significantly until distance exceeds 20 feet.
Does lighting play a significant role in speechreading?
No, but lighting should allow for not shadows and speechreader should have enough lighting to distinquish between background and speakers face.
What are optimal viewing angles for speechreading?
- - 0 to 45 degrees
- - 90 degrees not as good
What are some environmental cues of speechreading?
- -Pictorial and audiroty cues
- -Contextual and situational
What variables may make a speechreader mores sucessful?
- -Auditory sensitivity (amount of HL)
- -Auditory perception ( recognition, identification and understanding)
- -Age of onset (prelingual: lack language, postlingual: phonemic regression)
- -site of lesion
- -educational/ thereapy management (how many times goes to SP therapy or others)
Define visual perception in relevance to speechreading.
The cortex recieves the visual stimuli and enables us to perceive the inital lip movement as speech.
What are the 2 strategies of development of perceptual processing?
- 1) figure-ground patterning
- 2) closure
Define figure-ground patterning.
-the ability to focus on and perceive a target stimulus, or figure, from a background of other stimuli, or ground
*this strategy permits the hearing impaired person to separate meaningful visual and auditory events from abmient stimuli.
Define closure (visual perception strategy)
- The ability to combine or putll bits of information together in order to figure out what was said.
- *increased experience correlates to increased abilites to speechread.
Why is closure essential for the H.O.H.?
- Because due to their disorder and limited visual cues provided by speech, they receive distorted or fragmented auditory and visual stimuli
- Our reception of information ins based on perceptionand prediction
What is a formal speechreading test?
- May consist of syllables, words, sentences, stories or a combination of all of them.
- Presented in a Vision-Only condition without acoustic cues or combined visual and audiroty stimulation.
- Prerecorded or live face-to-face stimulation.
Why is evaluating vision so important?
- Visual acuity plays a vital role in decoding process.
- *even a mild visual acuity problem can have adverse effects on speechreading performance.
- -Sidenote: incidence of occular anomalies is more prevelant for hearing impaired children than their peers.
Deaf dependence on Vision
- Congenitally deaf individs may not have english language rules.
- This is a disadvantage because they will have to learn to decode without the auditory cues.
- They must learns the rules of the language before they can speechread.
H.O.H dependence on vision
- possess functional residual hearing to some extent
- less dependent on vision than Deaf
- Still receive considerably more info from the spoken code that is provided solely by their auditory channel.
What are the auditory verbal trends in speechreading?
- a unisensory philosophy of management for the hearing impaired that does not focus on speechreading.
- It tiries to maximize the auditory channel almost exclusively.
Who teaches AVT?
- LSLS: listenting and spoken language specialist
- LsLs Cert AVT: certified Auditory-Verbal therapist.
- *in sessions speechreading is often prevented in the clinic room.
What is total communication?
- philosophy of communicating with children who are deaf using on or several modes of communication.
- *including, oral lanuage, signed communication, written language, fingerspelling, gestures, facial expression and cued speech depending on the child's needs.
What are some goals of total communication? (children)
- Building the child's knowledge base concerning the speechreading process.
- develop an appreciation of benefits that speechreading can provide in perceiving speech.
- stimuli is based on each client's capabilities and needs in real like situations.
- clinical activities address the individual needs of each child.
What is the goal of total communication in adults?
To highlihght the benefits of using the visual skills that a patient already has in order to maximize speech perception abilities
What are 4 quick tips for speechreading?
- 1) be relatively clost to the speaker
- 2) watch the speaker's mouth, facial expressions and hand gestures
- 3) maximize your hearing with hearing aids and ALD's
- 4) let the talker know you have a hearing loss.
What are the 4 identigying physical characteristics of ASL?
- Hand configuration
What are some highlights of ASL?
- There is not a corresponding sign to represent each english word.
- ASL is NOT a form of English, but is a distinct language produced manually that requires just as unique a translation of English as does any foreign language.
What is SEE?
- Manually coded English, often used in educational setting to minimize the differences that exisit between spoken and written English and ASL.
- A system in which English words that appear in a message seigned in that same order.
What is fingerspelling?
- Manual communication where the sender spells the words with their fingers.
- speakers spell their message in the air by using handshapes to represent letters in the English alphabet
- *aka the manual alphabet
T/F Fingerspelling is the most efficient form of manual communication
- False, due to the rapidity of "spelling" a message, reception requires considerable practice and concentration.
- *used as supplement, to express proper names, technical terms and events that cannot be conveyed by signs.
Study of minimal units of language that are meaningul.
Study of sound systems used in language.
Functional use of language.
study of word meanings and word relations.
Governs the rules of how words are arranged in sentences.
What are the hearing loss effects on spoken language?
- 1)deteriorated speech signal (person will miss out on parts of form, content, and use)
- 2)Leads to delay in language
What are some factors that will affect hearing acquisition?
- 1) degree of loss
- 2) age of onset/ age of intervention
- 3)presence of other disabilities. (may have other disabilities that trump HL therapy)
What percentage of children with hearing loss have other special needs?
What are some predicting factors of early expressive language development?
- Child's age
- Age of identification (hearing loss)
- Cognitive status
- Presence of additional disabilities
- *sidenote: the greater the hearing loss, the greater the expected language delay!
What are 3 key factors that impact S&L outcomes?
- Increased patient diversity (eng not 1st lang)
- Early intervention!!!!!
- Availability of cochlear implants (remember, sev->prof loss)
If early identified at how many months will the child be most likely to catch up to their normal hearing peers?
before 24 months.
When trying to acheive early intervention what are the predictors of speech intelligibility?
- More advanced language development.
- Lesser degree of hearing loss.
- Oral mode of communication.
- Increased age.
What are the factors of cochlear implant use on language acquisition?
- Age of implantation (EARLIER the better)
- Amount of intervention
- Severity/progression of HL
T/F Implanted children still have a less thatn optimum acoustic signal that creates language, listening and academic difficulties.
Mothers of deaf chidren are less likely to use.... and more likely to use..
- Less likely to use:
- -Verbal praise
- -Ask for opinions
- -Ask for suggestions
- -Use questions
- More likely to use:
- -Give more suggestions
What are language characteristics of preschool H.O.H.?
- Hearing loss during the critical period of development may deprive the chid of unambiguous auditory and linguistic cues from language models.
- Lack of an auditory signal may severly compromise development of semantic,syntactic, mophologic, pragmatic and phonologic aspects.
- Increased chance for reading and academic difficulties.
What are the other forms of communication parents of deaf may use more of?
- Functional adaptations
- Visual communication
- Tactile attention-getting stategies
What is a schema? and why is it important?
- It is considered the language processing and planning that is developed through
- everyday interactions.
- Early language development is established through use of daily routines in the child's life.
How is knowledge of Schema in preschool children in normal hearing children different from those of HI?
- Children with normal hearing will hear parents talk during dinner, bath or bed time as well as over hear parents talking in other occasions.
- HI children may have limited access to the language their family is using daily.
- Also HI children may hear little conversations unless it is directed toward him or her.
What are the semantic and pragmatic functions in H.O.H preschool children?
Children with HI exhibit a full range of pragmatic functions, but limited semantic functions using nonverbal and verbal communication.
If a HI child is identified by 6 months and has normal cognitive function will have vocabulary similar to...
Children with normal hearing
What are the three major aspects of language evaluated in the language of H.O.H. school age children? (>2)
- Lexical-semantic skills
- Syntatic-mophologic skills
- Pragmatic skills
What is the lexical-semantic skills of school age H.O.H. children?
- May very from a mild to profound delay
- Reduced vocab is common with HL
- Sever delays in the acquisition of lexical-semantic skills were ovserved across all age groups from 5-20
What is the syntactic-morphologic skills of school age H.O.H children?
- Delay in lexical-semantic skills will aslo transfer into a delay of syntactic-morph skills.
- Restricted knowledge of word classes (nouns/verb usage)
- Restricted knowlede of syntax
- Syntatcic delay
- Deviant syntax with profound HI (word order, word endings, omission of major sentece constituents)
What is the pragmatic kills of school age H.O.H children?
- Many children with HL have difficulties with conversational turntaking, topic initiations and maintenance.
- *Sidenote: these skills progress as they get older, but are developed at a slower rate depending on age of ID and age of intervention.
What are the debates of plateau in language acquistion?
- Moeller found little growth in semantic and syntactic skills with severe HL after 12-13
- On the other hand Yoshinaga-Itano warns that language growth does occur after 12
What are some preliteracy and literacy issues of school age H.O.H children?
- In reference to reading and writing they may not have the exposure that normal hearing peers have.
- Phonological awareness may be a precursor to reading ability and is defined as the ability to recognize that words consist of individual syllable and phonemes.
- *Sidenote: Prelingual deafness may inhibit phonemic awareness this is possibly due to limited exposure.
What are the 3 categories of measures used for assessing the language of children with hearing impairment?
- 1) Communication checklists
- 2) Formal language tests
- 3) Communicating/language sample analysis
- *Sidenote: few measures of language are specifically designed for those children with HI. Do not compute or use mental ages or IQ scores because results only show language delay.
Why are printed tests a disadvantage to those that are HI?
The test may reflect their reading abilities rather than their language abilities.
What are ways to provide optimal environment for evaluation?
- First a listening/function of check of hearing aids/CIs should be performed before any evaluation.
- Reduce niose and distractions
- When giving oral instructions/materials, allow the child ull access to speechreading skills.
- *sidenote: the clinician needs to be proficient in the child's primary means of communication.
What are the treatment goals for language development of deaf children? (Carney and Moeller's)
- 1) Enhanced parent communication
- 2) Understanding of increasingly complex concepts and discourse
- 3) Acquisition of lexical and word knowledge.
- 4) Development of verbal reasoning skills.
- 5) Enhanced self-expression.
- 6) Development of narrative skills.
What is important about communication/language management?
- The goal is exposure to the child's everyday communication functions.
- Therapy should include facilitation of a wide range of everyday events and reasons and how to communicate about them it should not be solely direct language targets and forms.
What are strategies for developing conversational skills?
- 1) encourage the child to practice as a conversation to partner learning how to initiate, take turns and end conversations.
- 2) Use of recasting: when child uses incomplete or inappropriate forms during conversation, the adult rexasts the utterance mantaining the child's meaning, but providing the appropriate form.
What is a good way to create an opputunity for the child to communicate in routine situations?
- To get a child to use their pragmatic skills saboteur strategies may be used.
- These provide the child opportunities to use language that has been mastered
- *Ex: stand in front of them to elicit them to ask you to move.
Before what age is it most important to get an AABR done?
By what age can a baby discriminate sounds?
T/F Normal hearing children vocalize in an unordered sequence from birth to 1st words.
False, they follow a sequenced order.
What are the difference in sequence order of vocalization?
- Similar to hearing they coo, goo and babble.
- They tend to produce a greater proportion of velar back consonants at 12-15 mos.
- Fewer consonant-like sounds from 6-10 mos.
- Redup'd babbling around 11-25 mos with fewer instances than normal hearing babies.
What is speech intelligibility and how do you evaluate?
- Proportion fo speech understood by the listener.
- Eval involves recording the H.O.H. individ and then further evaluating word ID and overall intelligibility.
What are some factors that influence the scoring of intelligibility?
- 1) Experience of the listener with deaf speech.
- 2) Difficulty level of the vocabulary and sentence structure for the speaker.
Who is most likely to rate deaf speech with an intelligible?
An experienced listener of deaf speech.
What are the affects of speech intelligibility on perception of the HI?
- Effects daily conversation and others perceptions of a speaker's cognitive copetence and personality.
- *Sidenote: those with at least moderatly good intellig are perceived much more positively than spkrs with poor intellig.
The _____ of HL is directly related to te intelligibility of the person.
T/F children using oral communication models have better intelligibility.
- True this is because they have...
- - more intensive speech training
- - teacher in TC did not have expertise in speech training
- - higher expectations set by teachers and parents
- - peer use of speech
What are two key areas for speech concerns of those with HL?
- -Advancements in hearing aid/Ci technology provides greater access to speech acoustic cues than every before.
- -Speech training must be centered on overall communicative competence.
What are the 6 guidelines for achieving the areas of speech concerns? (prelingual)
- 1) integrate auditory and speech goals
- 2) follow a "dialogue" rather than "tutorial" format
- 3) use bridging activities to promote real world carryover
- 4)practice communication sabotage
- 5) usecontrasts inperception and production
- 6)select speech goals that enhance communicative competence
What is considered mild-mod sev and sev-prof ranges? (prelingual)
- Mild-mod sev<70 dB HL
- Sev-prof >70 dB HL
What are mild-mod sev speech characteristics? (prelingual)
- Errors: misarticulation of single consonants and consonant blends (mostly high freq)
- Due to the usual sloping hearing loss config, most errors for speech sounds are
- 1)low intensity
- 2) high freq
- 3) short duration
Mild to moderatly severe loss errors are of what manner and which type? (prelingual)
- Affricatives, fricatives and blends
- Substitutions, distortions and omissions
What are some areas not important for assessment of mild-mod sev? (prelingual)
- Vowel production
- Voice quality
- Suprasegmental features
What should therapy be aimed toward in mild to mod sev speech management? (prelingual)
articulation and/or phonological treatement
What should be considered during treatment of mild to mod sev speech management? (prelingual)
- 1) Use of visual and tactile cues to aid in speeh distinction
- 2)Familiarity with the child's aided thresholds to ID the speech sounds that are in the child's audible range
- 3) awareness of the impact of co-articulation, due to the change of soundsas the are paired with different speech sounds
What are speech characteristics of sev to prof range? (prelingual)
Average intellig for this type of HL is approx 20%
What are the characteristics of respiration for persons with sev to prof HL? (prelingual)
May speak only a few syllables on a single exhalation of air
What are the resonance characteristics of those with sev to prof HL? (prelingual)
- Resonance: the vibration of air in the throat and oral cavity and/or nasal cavity
- - problems include hypernasality and hyponasality
- *Sidenote: nasality is found in the lower freq's
What are the characteristics of phonation of sev to prof HL? (prelingual)
- Vowel prod's may invovle inadequate vocal fold adduction
- breathy voice quality
- perception of substituting vless and v or make vless into high freq v'd sounds
- decr control of fund freq
- varied speech intensity
What are some vowel error patterns of sev to prof HL? (prelingual)
- 1) vowel neutralization
- 2) diphthong and vowel confusion (ex: /aI/ for /a/
- 3) nasalization of vowels
What are some consonant error patterns of sev to prof HL? (prelingual)
- Voicing errors
- Omission and distortion of consonants (velar and final consonants)
- Omission of consonants in blends (top for stop)
- Nasalization of consonants
What is palatometry?
- Device fit to the patients palate and contains 96 electrodes for recording tongue to palate placement
- *sidenote: children with prof Hloss have idiosyncratic tongue to palate contacts
What is a suprasegmental aspect?
Important because they communicate an indivuidual's emotional intent, urgency of message and linguistic stress which includes changes in duration, intensity and fundamental freq scross syllables in an utterance.
Those with sev to prof Hloss speak at an overall rate of ___ to ___ times slower than speakers with normal hearing.
Speech assessment of sev to prof HL should include...
Measures of intelligibility, articulation and phonology, suprasegmental features and voice characteristics
When measuring speech intellig of sev to prof some variables inclulde?
- 1) complexity of vocab and sentences spoken
- 2) presence/absence of contextual cues
- 3) presence/absence of visual and speechreading cues
- 4) listener experience with deaf speech
What is some aspects of articulatory and phonology measures of speech intelligibility of the sev and prof HL?
- Test are not normed of children with hearing loss but do give accurate measures to incorrect pronunciation.
- They may imitate or produce a large number of speech sounds but do not use them correctly to produce words in ongoing speech.
What did Ling suggest to record for an evaluation of discourse?
conversation, description, narration, question and explanation.
T/F There is an extreme variability in error patterns among individuals.
What are four approaches to enhance speech training for sev to prof HL?
- 1) early and consistent use of hearing to optimize residual hearing.
- 2) anatomic and pictorial monitoring
- 3) visual cues
- 4) use of complex feeback aids
It is important to ______ the use of residual hearing for speech management.
What is the use of pictorial and anatomic monitoring of speech management of those with sev-prof HL?
- Anatomic charts, saggital sections of the head with mobile articlators and pictures of the tongue shape
- *sidenote: pictures are less favorable de to the lack of movement
What is the use of visual stimulation for speech management of sev to prog HL?
- Usually involves a mirror to see visual feedback
- *sidenote: this should be limited as visual contexts of sounds change as function of context (shoe looks different that she [sh])
Describe the complex feedback of speech management for sev to prof HL.
- Uses devices to provide visual monitoring of acoustic features of speech
- *sidenote: used primarily as a supplement in a treatment plan
Postlingual profound loss producesa gradual ______ of speech.
What are specific speech errors of postlingual profound HL?
- Decr vowl space due to centralization of the first two formants
- inaccurate production of /s/ and /sh/ (high freq)
- similar voice onset time values for v'd and vless plosives
- subs of /r/ and /w/
- tendency to omit consonants in the final position of words.
What is responsible for intervention?
- Audiologist: monitor hearing sensitivity, monitor amplification devices and communicate to tothers the effect of HL on speech acquisition.
- SLP: stay current with language intervention techniques, establish family centere intervention.