-
What are the two visual properties of speech?
-
What is a viseme?
What can you compare it too?
- The visual unit of speech
- Phoneme- the acoustic unit of speech
-
How many visemes are there for English speech.
10. All english phonemes fall into 1 of 10 discrete visual categories.
-
What are homophenes?
- Speech sounds within the same visual category (homophenous)
- *look but don't sound the same.
-
What are the 3 more recognizable visemes?
1) p,b,m
2) f, v
3) w, hw, r
-
What are the 5 less recognizable visemes?
- 1) Th and th (voiced and unvoiced th)
- 2) Sh, ch, j, ig (beige)
- 3) s, z
- 4) j (yellow)
- 5) t, d, n, l
-
What are the 2 visemes with very little visual information?
-
Vowels are ___ in acoustics but ___ in visual.
-
____ of words and phonemes are homophenous.
50%
-
How many phonemes are heard and seen per second?
- Speech - 15 phonemes/sec
- Eye- 12 phonemes/sec
-
What are limiting factors in lipreading?
- 50% of words and phonemes are homophenous
- Speech-15 phonemes/sec Eye- 12 phonemes/sec
- Running speech
- Different speakers ( artic movements, familiarity, rate, oral prosthetic, disordered artic, whisper)
- Visual Noise (poor lighting, glare, hand in front of face, food chewing, cigarette, pipe, truning away, gum chewing, mustache beard.
-
When you whisper...
Articulation is different.
-
Define speech reading
the process of decoding the visual cues of speech.
-
WHat are the two speech reading methods and describe each. Also give examples of each
- Analytic method: breaking message down in little parts. Drill on sounds. mueller-walle, jena
- Synthetic method: pull everything together from all info w/o focusing on little parts. nitchie, and kinzie
-
Who is the father of lipreading?
Nitchie
-
What is the more popular method of speech reading today?
Synthetic
-
What is the classic test of speechreading?
- The Utley test,
- Not sure of validity due to lack of science.
-
There are a variety of other tests for speech reading assessment, and some are designed to evaluate _____ rather than ___ skills.
-
What things must you specify for testing conditions of speech reading?
- who is the speaker
- acoutsic cues (signal level, noise level, SNR.)
- Speaker position
- gestures, facial expression
- speaker distance
- rate of speech
- lighting (make sure its good)
-
what should test administration always include?
voicing.
-
Who is a candidate for speechreading instruction?
those persons with substantial disability whom other AR techniques have not been effective.
-
What are the factors that mean S/R is usually not a priority in an AR program?
- limitation of S/R
- difficulty learning s/r in a training program
- availability of more effective AR techniques.
-
What are two perceptual strategies in understanding speech? Describe each and give an example.
- Figure-ground patterning: Recognizing a stimulus pattern in a background of noise. (focusing in on what you want to focus on in the midst of noise). EX- word search
- Closure: Perception of an incomplete stimulus as being complete. Ex- A win__r _orm warn_ng is in e_e_t
-
____ is important in communication and quality of life.
Vision.
-
_____ are often present in clinical populations. Which one?
- Visual disorders.
- elderly
- multiply disordered individuals.
-
What is acuity?
Ability to resolve visual stimuli.
-
Describe 20/20
20/20 vision is a term used to express normal visual acuity (the clarity or sharpness of vision) measured at a distance of 20 ft. if you have 20/20 vision you can see clearly at 20 feet what should normally be seen at that distance.
-
What does it mean to have 20/100 vision?
it means that you must be as close as 20 ft to see what a person with normal vision can see at 100 feet.
-
What is adaptation?
Ability to adjust sensitivity to light.
-
Describe Retinitis pigmentosa?
Genetic. Occurs in usher syndrome.
-
What is the most common disorder causing loss of both hearing and vision (may also affect balance)?
Usher syndrome
-
With usher syndrom, hl is often _____ and vision loss occurs in ___ to ___.
- congenital
- childhood, late teens
-
With Usher syndrome, there is a decrease in _____ a loss of ___ and _____.Usually not ______.
- night vision
- peripheral and central vision (in advanced cases)
- complete blindness.
-
what is in the future for usher syndrome?
promising research (nature medicine 2013) treating HL in Ushers with RNA injection.
-
What are the 4 most common age related visual disorders?
- cataracts
- glaucoma
- macular degeneration
- diabetic retinopathy
-
Describe cataracts
Clouding of lens.
-
Descrive glaucoma
- usually excessive pressure in eye
- group of diseases that cause optic nerve damage
- second leading cause of blindness
- early treatment can prevent damage
-
Describe macular degeneration.
- Affects central part of retina
- Central vision may blur and eventually advance to a central blindspot.
-
Describe diabetic retinopathy
Damaged blood vessels on retina.
-
What is the retina?
The light sensitive tissue at back of eye.
-
In children, visual disorders may be related to ____.
Hearing loss
-
In children, following diagnosis of sensorineural HL (and some conductive HL e.g. craniofacial), what must occur?
Referral to vision specialist
-
What is deafblindness?
combined hearing loss and visual impairment
-
Describe the range of impairment, prevalence, etiologies and key qualities of deafblindness.
- range of impairment ranges for both hearing and vision.
- estimated present in 3/100,000 newborns
- rubella, usher's syndrom and other genetic disorders, illness, trauma
- often severe communication, learning and mobility problems.
-
Compare and contrast vision care providers and hearing care providers.
- Vision Care Providers:
- *Opthalmologist (m.d., surgery)
- *Optometrist (O.D., Doctor of optometry, 4 year grad program, some diagnosis and treatment, prescribe some meds)
- * Optician (fills lens perscriptions)
- Hearing Care:
- * Otologist or otolaryngologist (M.D)
- *Aduiologist (AUD)
- * Hearing and dispenser
-
What are three types of cues to speech perception?
- Acoustic cues
- visual cues
- linguistic cues
-
What are three linguistic constraints?
- Lexical
- Structural
- Contextual
-
What are lexical constraints?
Closed set of phonemes and words
-
What are structural constraints?
rules for stringing together words and phonemes
-
what are contextual constraints
Topic of conversation, speaker-listener relationship setting.
-
What is redundancy?
The part of the message that can be lost without significant loss of information *both auditory and visually*
-
What is the communication model
- Speaker ----- encoding and monitoring speech-----message
- -----------decoding
- -----------------listener
- ---------ENVIRONMENT--------------
-
Research studies provide...
selected pieces of information regarding paterns of language performance.
-
HI persons are a very __________ and any individual may fit the _____.
- Heterogenous group
- Pattern
-
language is extremely ___
complex
-
Normal acquisition is through_____
everyday exposure 24/7
-
HL prevents or reduces?
exposure
-
Earlier onset & more sever HL =
greater deficit
-
HL can cause both ___ and ____
language disorder and delay
-
HL can produce profound _____
language deficit
-
Profound language deficit can result in profound impact on:
- Social and emotional relationships
- communication
- reading
- academic performance
- career
-
Describe the 7 characteristics of vocabulary related to hl.
- related to age of onset of HL
- Related to degree of HL
- Significantly smaller vocabulary
- Gap between HL and normals widens as age increases
- Islands of deficit (certain situations kids w/ HL are not exposed to)
- Poor understanding of idioms, puns, multiple meanings and subtle differences
- Poor understanding of function words (conjunctions, prepositions, compared to semantic words (nouns))
-
Describe syntax as it relates to hl
- Related to degree of HL
- Use shorter sentences
- Use simpler sentences
- Poor understanding of complex sentences
- poor understanding of passive voice
- errors difficult to overcome
-
Describe morphology as it is related to hl
certain morphemes are in audible (especially s and z)
-
What percentage of deaf children are of normal hearing parents ?
92%
-
_____ have better language skills than_____ due to ______.
- Deaf kids from deaf parents
- those with normal hearing parents
- consistent language exposure.
- *before cochlear implants.
-
Describe the speech characteristics of the HI?
- Acoustic input is critical for development of speech.
- -hearing others
- -hearing self (cannot self monitor)
-
Describe the babble behavior in deaf infants.
- Start to babble like normal (throws parents off)
- Difference is that babble does not progress and may regress.
-
Describe the speech characteristics of mile/moderate HL
- Normal voice quality
- Normal vowel articulation
- Some consonant misarticulating (final consonants and fricatives
- *Speech is pretty normal*
-
Describe the speech characteristics of profound HL
- Deaf speech
- poor coordination of breathing and speech
- flat intonation contour --- monotone
- high pitch voice (putting in more effort)
- hypernasal (they can hear nasals better)
- articulation errors for both vowels and consonants
- poor control of pitch and loudness
- poor differentiation of vowels
- omission of consonants
- poor rhythm of speech
-
The first management procedure is ? Describe the process of the first class
- Speech reading instruction:
- Be creative
- make session interesting
- group is hard to facilitate
- introduce clients to each other
- determine client occupations, interests
- explain the audiogram and typical high-freq. hearing loss
- Talk briefly about hearing aid
- discuss the communication model (don't get to academic)
- Prepare and distribute handouts
- Administer a hearing handicap scale; situational, psychosocial
- Briefly demonstrate the process of speech reading
- Give homework: over the time period until the next session, list situations in which it is especially difficult for you to hear clearly.
-
Describe the second class
- Class two:
- Discuss hw
- s/r pre test
- discuss pretest results
- briefly discuss visibility of speech sounds
- present most recognizable visemes
- S/R exercises -- for example, QRE (quick recognition exercise)
- Homework: watch and analyze three different news casters without sound.
-
Describe the 3rd class of speech reading
- discuss homework
- more visemes
- more exercises
- S/R post tests.
-
Describe the QRE
- Write 3 words up on board (pitch, fish, rich) that look different
- 1) Say words and they listen
- 2) Say it and point
- 3) Say them with you
- 4) you say it and they repeat it.
-
What is meant by environmental control?
- -A management procedure
- Manipulate environment to perceive better cues
- get in position for auditor and visual cues
- avoid noise
- avoid reverberation
- *Don't talk down to them*
- achieve proper lighting
- assert yourself (not aggressive)
-
Sign language is used for what type of hearing loss?
profound hl
-
what are the 3 components of manual communication
gestures, fingerspelling, signs
-
what is iconic?
look like what they signify
-
What are the sign features?
- position
- configuration
- orientation
- movement
-
Know the sign language interpretation symbol.
-
Describe american sign language
- asl or ameslan
- a non-English lanuage
- The language of the deaf community
- No written form (ie text for everyday reading)
-
Describe manual english
- english language in signs
- a sign for every pronoun, prefix, suffix, etc.
- english order
- many signs the same as asl
- used predominantly only in educational setting (used in schools to teach english)
-
Compare SEE I, SEE II, signed english
- SEE I: seeing essential english (early 1970's)
- SEE II: Signing exact english
- Signed english: developed at gallaudet university
-
What is LOVE
Linguistics of visual english
-
Interpreting =
used to fascilitate communication between haring ad hearing impaired individuals.
-
www. rid.org
registry of interpreters for the deaf
-
certificate of interpretation
between asl and spoken english
-
Certificate of transliteration?
between signed english and spoken english
-
What are the rules for hearing people using an interpretor
- Talk directly to HI person
- Short breaks
- Don't ask for interpretation of just part of message
- Furnish interpretor with technical vocabulary ahead of time
- Be prepared to slow speech
- only one person should talk at a time.
-
Describe the interpreter position.
- 1:1 conversation behind HI person
- Classroom - near instructor
- good lighting
- slide/video presentation near presenter
- Group meeting
- stage presentation.
-
What is the association connected with tinnitus
american tinitus association
-
When a client has tinnitus you should...
referral to ENT physician or an audiologist who specialized in tinnitus.
-
what are the common treatments for tinnitus
- Hearing aids (won't hear tinnitus)
- Tinnitus masker
- simple maskers (radio)
- counsling
- Tinnitus retraining therapy
- Biofeedback
- Support group
- drugs
- Diet (less caffine)
-
What is residual inhibition?
- goes with tinnitus masker
- absence of tinnitus for a short time after masking is removed (in HA too)
-
Describe tinnitus retraining therapy?
- long term
- expensive
- good and bad reports
-
biofeedback=
relaxation tech using electrodes
-
Amplification is the _______.
Best treatment for hearing loss
-
What are the amplification and other electronc devices
- Hearing aids
- auditory trainers
- assistive listening devices
- cochlear implants
- tactile aids
-
What is the goal of amplification?
intensify speech sounds that are inaudible.
-
Who is responsible for ensuring safety and effectiveness of hearing aids?
The food and drug administration
-
what are the 4 basic components of a hearing aid?
- 1) Microphone(changes sound to electricity)
- 2) Amplifier (increases magnitude of electrical signal)
- 3) receiver (changes electrical signal back to sound)
- 4) Power supply ( battery or plugged in)
-
What is the order of using a hearing aid.
1) Sound---->2 Microphone------> 3) Amplifier --->4) Receiver ----> 5) ear mold ----> 6) ear
-
List devices that have essentially the same components for any audio amplification
- Cell phone
- radio/tv
- amplification system in church or lecture hall
- home stereo system
- classroom amplification
- mega phone
-
What are the three electroacoustic characteristics f hearing aids?
- Gain (volume)
- Frequency Response
- OSPL (output sound pressure level)
-
Describe gain
- The amount o amplification by the HA (input sound and gain = output sound)
- gain= use gain and reserve gain (amount you use and amount available)
-
Describe frequency response
- relative gain across frequencies
- tailored to compensate for the HL
- typically, increase high-frequency, sound and reduce low frequency sound.
- Programmable on a HA
- Treble and bass controls on a radio or other music playing device.
-
Describe OSPL.
Study the graph
The maximum output of the HA in dB SPL
-
BTE=
Reduced visability and acoustic advantages have produced a resurgence in BTE popularity
-
What is the most common hearing aid now?
BTE
-
What is meant by reduced visability?
- small size of HA
- clear smooth triming
- absence of ear mold in many cases.
-
Describe the BTE characteristics?
- most commonly fit
- typically best acoustic benefit
- engneered to reduce feedback
- multiple channels:program multiple settings
- ear level is better for localization and head shadow effects
- suitable for directional feature
- sufficient power.
-
Describe the characteristics of the Body aid?
- rarely fit (young children still use)
- heavy
- aesthetic (not attractive)
- body baffle
- clothing noise
- poor localization cues
- commonly worn in harness (front or back)
-
when was the body aid most popular
1980's
-
Describe the characteristics of the ITE
- commonly fit
- good benefit for some
- custom fit to patient
- not available for comparison (cant try on before buying)
- difficult to modify shell if poor or sore fit- may need to remake
- more feedback
- earwax issues
- battery controls smaller and harder to handle
- safely (breakage in ear--children)
- less adaptable to remote mic and other features.
-
How old is the ITE?
40 years old
-
ITC=
similar advantages and disadvantages re: the ITE, sometimes more pronounced.
-
Describe the CIC
- Similar to ITE
- Stem or string to remove
- resonance advantage of concha
- close to eardrum, requires less power
- aesthetically preferred
-
Describe the Deep and Fit
- Worn up to 4 months w/o removing
- must be professionally placed
- battery lasts 4 months
- soft seal- breathable, water resistant
- consumer can remove if necessary (so, not considered implantable) hook loops to remove
- consumer buys a years worth of the service (receives new units as needed within that year.)
-
There is not compelling evidence for use of the ______ over a standard HA
implantable ha for s/n hl
-
Implantable HA for S/N HL uses a ___. Costs ____ and DR. Primus does not know why__
- Transducer (changing energy to electricity) lightly touches ossicles
- ~30,000
- why people get them.
-
Describe Eyeglass HA (historic)
- Rarely fit, mostly historical
- more expensive
- fit problems for the glasses
- problems with bifocals, trifocals (problems)
- Limited selection
- replacement dilema (HA and Glasses)
- Repair (lose both vision and hearing)
- Advantage for CROS
-
What is CROS?
one ear is not working so you could put wire through frames.
-
Describe bone conduction HA
- metal head band
- elastic head band - more for kids who will probably get BAHA after 5 yrs
- Usually good outcome
-
BAHA
- Advantage
- Primary uses
- Bone anchored HA
- Very stable signal into skull
- no headband or other accessory
- 1. bilateral conductiveHL (permanent or long term Ex: bilateral atresia
- 2. Persons with one aidable ear.
-
When did hearing screening start?
1992
-
What is the first screening and how many will pass the second screening after failing the first?
-
How many of wyoming infants with HL are diagnosed with HL under the age of 3 months
98%
-
___ have hearing loss @ birht in wyoming.
3/1000
-
Are hearing and understading the same?
NO
-
How loud can you listen to an ipod and for how long, without damage?
60% volume for 2 hours
-
Some BTEs are receiver _________ units
in the canal
-
What are the identifying components of hearing aids?
- Make (name)
- Model (combination of letters and numbers)
- Serial number (different for left and right)
- Year of manufacturer.
- Microphone port (opening to microphone
- Battery Compartment (usually on end)
- Elbow (ear hook)
-
What are the controls on older hearing aids?
- gain (volume) wheel (not linear- not even in between levels)
- OTM (on back side. Off, telephone, microphone)
- H or HF switch (high frequency- good in noisy situation)
- Additional controls
-
What are the controls on newer HA?
- Controls may or may not be present
- Volume
- t-coil
- directionality
- channel
- *programming determines if they will be active or automatic
- *many users prefer totally automatic function.
-
What are the 11 HA features?
- Volume control
- telecoil
- Bluetooth
- Channels
- Directional microphone
- Environmental noise reduction
- Impulse noise reduction
- Wind noise reduction
- Feedback reduction
- WDRC
- Digital technology
-
Describe Volume Control.
- One manual-control option
- *Touch control (like an iphone)
- *Touch to change program
- *Sweep to change program
-
Describe Telecoil.
- T-coil
- Receives signals from telephone--electromagnetic.
-
Describe Bluetooth
Recieves external signals from telephone, ipod, tv--RADIO WAVES
-
Describe Channels
Listening programs that are designed for specific listening environments
-
People tend to use how many listening programs?
one
-
Describe directional microphones vs omnidirectional
- omnidirectional = equally sensitive to 360 degrees
- Improves SNR in typical communication situations
- Most newer HA have microphones that switch automatically into directional mode under certain conditions.
-
Describe how directional microphones came about and the idea of rear view mirror directionality
Designed for new york city taxi drivers - sensitivity to rear not front
-
Are directional microphones typically appropriate for young children? Why?
- NO
- Children often don't look at person they are talking to
- Incidental listening
- saftey (hearing everything around.
-
Describe Environmental noise reduction
HA attempts to automatically sense the presence of non-speech sounds (background noise) and attempts to filter-out the noise
-
Describe Impulse noise reduction
HA automatically senses the presence of very brief, impact sounds and attempts to suppress them
-
Describe WInd noise reduction
HA automatically senses wind turbulence across the mic and suppresses the noise produced
-
Describe Feedback reduction
- HA automatically senses feedback occuring and electronically suppresses it (improved in last several years)
- Allows open ear canal in many cases because of improvements
-
What is WDRC
- Wide Dynamic Range Compression
- Relates to OSPL output SPL = maximum level hearing aid can amplify.
-
Loud sounds are just as loud for ______ as for _____
- sensorineural HL as for normals (Recruitment)
- = Reduced dynamic range
-
A WDRC would squeeze 0-80 dB sounds into what range
30
-
WDRC allows soft sounds to be processed with______
Medium sounds are processed with ________
Loud sounds receive ________
- little or no compression
- moderate compression
- substantial compression
-
Describe Digital technology
- Most new HA are digital
- Greater Resolution (clearer) and control of digital (vs. Analog) signals.
-
What is the average cost of a newer pair of HAs?
$3000-$7000
-
MOst people wear ______ HA
binaural
-
HA technology developed at the same time as ____
batteries
-
The development and reduction in size of HA is in part dependent on ______
development of batteries
-
How many volts do HA batteries usually produce?
1.4 volts
-
Describe battery sizes
- 675 (bigger
- 13 (thicker with smaller diameter
- 312 (flatter and most common)
- 10
- 5
-
What element is most commonly found in batteries?
- Zinc Air
- -Remove sticker to activate
- - Shelf life up to 3 years if battery remains sealed
-
Do we use rechargable batteries for HA?
Some rechargable available, but problems with initial cost and replacement
-
How much does a HA battery cost?
4.50-$1.50 each
-
What is the battery life of HA?
- Varies with HA type and user
- ~ 10 days
-
What is meant by shelf life? what is recommended
How long they last on the shelf. Purchase fresh batteries.
-
How can batteries be inserted?
Insertion one-way.
-
What organization deals with battery ingestion and who is likely to ingest batteries
- National button battery Ingestion Hotline
- (202) 625 -3333
- 8-16 months most common
- seniors
- competent adults
- dogs
-
What is a battery caddy?
Carry extra batteries with you
-
What is the discharge pattern of HA?
Flat- stay at stable level but quit all at once
-
Many people use ____ to check the level of volts the battery is producing
battery checker
-
What volts do hearing aids put out
1.4 volts
-
Size determines _____ not ______.
How long it lasts not VOLTAGE
-
At what voltage should you throw your hearing aid away.
1.0v
-
Who should wear hearing aids
A person who needs them, benefits from them, wants them
-
Need of HA increases with what?
Benefit is greatest for who?
- degree of HL
- Persons with moderate to severe hearing loss.
-
-
What are the two ways to evaluate hearing aids, and describe first?
- Real ear measurements
- - measure HA output with mic in ear canal, match output to HL (audiogram).
- Subjective
- -during clinical evaluation, 30 day trial *can return it if you dont like it*
-
Earmolds can be ___ or ____
custom or general
-
when you have more severe feedback you should have what size ear mold?
Bigger
-
The earmold helps to
Hold the hearing aid in place.
-
Many hearing aids are ____ but others are connected to ____/
- Open fit with no ear mold
- to a earmold
-
How do you make a hearing aid?
- Audiologist makes an impression of the ear
- -cotton damn past second turn in canal
- -use syringe to push putty into ear
- -wait 10 minutes
-
Who produces the final product and how much does it cost
-
What are the functions of an earmold?
- to hold the HA securely on the ear
- to modify acoustics
- =higher frequencies= more open
- Also made for custom earplugs to protect ears from (water, noise)
-
What are the 5 parts of a hearing aid? Label on work sheet.
- Canal
- Sound bore :inside of canal portion
- Snap ring:receives button receiver (body HA)
- Helix: Slips in helix flap of concha, last in holds mold, causes most soreness and can be cut off.
- Concha rim: fits in concha
-
What are the two materials used for earmolds? Who usually gets which
- Hard lucite: hard, clear, smooth plastic. Easy to clean--ADULTS
- Soft: rubbery, sillacone, snug fit ---KIDS
-
Modifications on earmolds can be performed to...
enhance high frequencies and reduce low frequencies
-
earmolds supplement ____
electronic modification of the HA
-
Describe venting
- allow low frequency sound to escape
- allows natural sounds to enter
- allows ventilation
-
What is the overall effect of venting and one potential problem
- Improved speech understanding
- natural sound quality
- decreased loudness
- PROBLEM= FEEDBACK
-
When fitting an earmold, what are you concerned with
- Feedback (snug fit = less feedback)
- Comfort
- Securing the HA on the ear (disfigured pinna, huggie aid, toupee tape (double sided tape.))
-
What is one way to prevent loss of the earmold and HA on kids?
Fun clips
-
What are the two ways of doing earmold impression?
- Impression material that sets up in ~10 min
- New way of digital imaging
-
Where does earmold tubing attach to HA.
tubing glues to earmold and attaches to the elbow on the HA
-
Earmold tubing can get old which may allow what? Also it is______
- feedback or HA not being secure
- easy inexpensive to replace.
-
How do you clean an earmold?
- Remove HA
- Warm soapy water (do not use alcohol or cleaning fluid)
- Clear all water from tubing (squeeze bulb)
-
you should NEVER expose hearing aids to ___-
WATER
-
How do you manage feedback?
- Consult audiologist
- Snug earmold fit
- eliminate or reduce vent size
- soft earmold material (clings to ear)
- Seperate microphone from sound output (body HA)
- Do not reduce gain except as a temporary solution
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