Aural Rehab Test Review PDF

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This is a comprehensive review with notes from each powerpoint and lecture needed to pass the exam....

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Aural Rehabilitation Quiz #2 Review Content from Chapters 6-9

Lecture 6 Part 1 Basic Communication Model: - Source/speaker: where the auditory message originates. - Message: thought that needs to be expressed (may also include visual cues) - Feedback: provides opportunity for adjustments to occur. The speaker adjusts their speech depending on the feedback they get (verbal or non verbal, i.e., head nod) - Environment: communication situation in which the message is conveyed. - Receiver/Listener *A problem with any one of these steps will have an effect on the perception of the message Goal for patients with HL: Maximize residual hearing with hearing aids, cochlear implants and/or assistive listening devices. Auditory Perception - Segmentals: individual speech sound - Suprasegmentals: rate, rhythm, intonation, attributes of speech *Our ability to communicate depends on the auditory perception of the above features - Redundancy: information embedded in the message more than once - Transitional Cues: also effects speech perception. *Acoustic byproducts caused by dynamic movement of the articulators in production of adjacent phonemes (coarticulation, timing, stresses, pauses) *Vowel duration, vowel  consonant can be used as closure if consonant is not heard. T helps fill in the message and what phoneme may be next. - Linguistic Constraints: contextual information/help with parts missing. *Ex: topic of conversation will help; structural linguistic constraints where we use our top down knowledge of how phonemes and words are strung together to extract information, AKA, phonological cues. Basic Auditory Perception Abilities -The human ear perceives auditory signals ranging from 20-20,000 Hz. Speech Spectrum: 50-10,000 Hz. The most important on audiogram is 125-8,000 Hz. -Audible range (typical ear) is from 0 dBSPL to 130-140 dBSPL -Threshold of Pain: 140 dBSPL (could differ based on individual) -Unborn infants can perceive auditory stimuli from about 18 weeks gestation.

Acoustic Intensity of Speech -Avg. speech is 45 dBHL (65 dBSPL) -Avg, shout is 65 dBHL (85 dBSPL) -Typical male speakers have overall intensity 3dB > females Phonemes - Smallest unit of speech that can signal linguistic meaning. - 40 phonemes in the English language. - Phonemes are separated into two classes that have acoustic characteristics in common (i.e., vowels, consonants) - Most speech energy found below 100 Hz (vowels) *Mot powerful phoneme is “aw” as in “thought”. It is 680x more powerful than the weakest phoneme fricative “th” found in “eighth” The difference is about 28 dB. Segmentals- individual speech sounds that consist of numerous features that associate with both vowels and consonants Vowels - Low and mid frequency energy - Defined by formant frequencies (band of harmonics that are resonated) - Form power behind speech; always voiced and sound waves produced at level of the larynx, vocal tract is acoustic resonator that modifies the spectrum of laryngeal waveform. - Various resonances from vocal tract. - Formants provide acoustic cues for id of vowels (only hear first or second formants to be able to perceive the vowel_ Consonants - Predominantly high frequency and broader - Categorized by place and manner of articulator and voicing features. - Important to determine speech intelligibility. - When voicing is not used, a substantial constriction of articulators I needed. - They do not carry a lot of intensity, but plays a critical role in speech perception ability. Suprasegmental Features -primarily are present in the low frequencies, through the fundamental frequency (not confined to any phonemic or segment) -Includes rate, rhythm, intonation- superimposed throughout speech. *The ability to communicate depends upon auditory perception of segmental and suprasegmental feats. Temporal Parameters (Timing) - Rate of speech differs - Normal rate= 12 phonemes/second - If the speaker is excited it can go as great as 20 phonemes/second. - Rapid speech is always difficult for those with HL because it contains less redundancies, fewer segmental and suprasegmental cues and transitional cues.

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Involves duration of individual speech sounds. Vowels have longer duration than consonants. When a phoneme is introduced with other phonemes, this alters intensity, frequency, and durational properties (these cues make up a large portion of the total speech sound signal and is important for speech perception- contains valuable information.) *Rate impacts understanding for the hearing impaired.

Using Redundancy - Listener can use semantics, syntax of situational constraints to define the message. o Syntax= grammatical rules of language o Symantical= sentences have relationships, how they connect to the ones before and after. o Situational= social/physical context. - NOISE is a confounding variable that will REDUCE REDUNDANCY o Reduces overall cues o Reduce predictability Components of Speech Perception (understanding) & Comprehension *Model of auditory therapy includes these 7 steps - Detection: (or reception/awareness) basic aspect of perception; if sound is not received it cannot be detected or if a person is unaware of sound. - Discrimination: difference between 2 or more sounds. - Identification: the labeling/pointing (used with children too young for speech) to something one has heard. - Attention - Memory - Closure: speech elements are brought together into a measurable whole/helps to recognize speech/ important to fill in missing spaces and gaps for those with HL. - Comprehension: full understanding of auditory stimulus.

Clinical Application/Goal Writing -Long Term Goal (LTG): specific and measurable -Short Term Objectives (STO): steps implemented to achieve long-term goals - For example: LTG= J. will correctly identify animal sounds without prompting 85% of the time. *The first STO cannot jump to identification, since that is step #3. Must first start with detection, step #1.

STO #1: J. will demonstrate awareness of sound presence vs. absence 95% of the time. STO #2: J. will correctly discriminate between animal sounds with prompting 95% of the time. STO #3: J. will correctly identify animal sounds with minimal prompting 85% of the time. *You must go through each step/component of speech perception to get to comprehension. Speech Perception & Hearing Loss Our success in processing speech is related to: 1. Physical Properties (of the coded acoustic message) a. Frequency rate the message is in. b. Decibel level of the message c. Where the patient’s HL is. (Can they hear within that range?) 2. Redundancy (acoustic, linguistic, contextual, visual) a. Predictability of speech b. Better redundancy=better odds listener will predict what was said. 3. Noise a. Factors that are counterproductive to receiving a message/communication. b. Doesn’t just include background noise, but also poor syntax. (Anything that interferes with perception of stimulus) Speech Banana -The target hearing area for children with HL. -Where the speech sounds fall on an audiogram. Assessing Speech Perception -Which phonemes patient is able to perceive with HL. -Count the dot audiogram method alone will underestimate listening changes for most children. (For example in a class we have to consider distance from speaker, acoustic reverberation, background noise, etc.) Acoustics - Less sensitive in low and high frequencies sound range and more sensitive to mid frequency range (with greatest sensitivity between 3K-4K Hz.) - 0 dBSPL: lowest level/threshold that humans can hear sounds. *Even though sound is present below 0dBSPL, the lowest level that humans can hear sound is 3K-4K Hz. - Audible intensity range- 0dBSPL  Threshold of pain (140 dBSPL) *Most conversations occur at 40 dBSPL -Humans are capable of distinguishing between 340,000 tones (by changes in frequency, duration, and pitch)

-Frequency range for speech= 50Hz  10,000 Hz. *Most speech energy below 1000 Hz. *Pitch for males=130 Hz. *Pitch for females= 260 Hz. *Pitch for children= 400 Hz. Peak resonances/Formant frequencies= range of frequencies that occur after initial onset of sound. -This happens for voice sounds starting at the vocal folds. -Shaped by filtering of articulators and will change overall intensity and frequency characteristics of sounds. _________________________________________________________________________________________________

Lecture 7: Auditory Training -Most commonly associated with aural rehab. -Focuses on developing patient’s ability to recognize speech using the auditory signal. -Requires use of residual hearing to improve communication ability. -Differences and similarities in approach for children and adults. -Benefits of auditory training have increased with advancements in hearing aids and cochlear implants. History - Dates back to 19th century in Europe. - Max Goldstein- created acoustic method (used stimulation with individual speech sounds, words, and sentences; focused on family hearing impaired). Considered the father of modern audiology. - Raymond Carhart- (1912-1975) The father of audiology; developed procedures for adults and children. For children- he thought it was important to go through normal auditory stages. For adults he reeducated them. Today… - Patients must have hearing aids or cochlear implants to maximize residual hearing. - Incorporated computer based training programs- makes it easier for patients to practice techniques on their own. - Analytic method: o drill work; components of speech are broken down and practice with reception of various consonants, phonemes and syllables. o Sound awareness must be established first. o Gross sound discrimination for loudness, pitch, and rate are often done. o Vowels targeted for low frequencies- consider formant frequencies o Consonants for high frequencies- contrast place, voicing and manner  Voicing and manner easier to discriminate. - Synthetic method: o More global approach.

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o Stresses understanding of various cues from the syntax and context of spoken message to derive meaning. o Begins with simple discrimination (stress, intonation, loudness) o Clinician helps patient to discriminate multi word utterances o Identify simple words from a closed set. Pragmatic method: o refers to effectively using communication strategies and improving the listening situation by improving the signal to noise ratio and reducing communication breakdowns. Eclectic Method: o Using strategies form each of the 3 above methods and various curricula that has been developed based on the auditory developmental hierarchy. (Methods based upon work of Erber) DASLII (Developmental Approach to Successful Listening): o consists of hierarchy of successful listening skills in various sessions: sound awareness, phonetic listening and auditory comprehension. o Developing sound awareness subskills as well. SKI-HI o Comprehensive method commonly for infants o Follows 11 different skill levels in auditory development ranging from attending  speech use. SPICE (Speech perception instructional curriculum and evaluation) o Developed for evaluation and treatment for children with severe and profound HL and helps to develop auditory skills. o Follows basic skills in speech perception: detection, Suprasegmentals, vowels, and consonants perception as well as listening skills.

Erber (1982) Levels of Auditory Perception Detection  Discrimination  Identification  Comprehension *Treatment should follow this hierarchy. Formal Auditory Training - Planned approach - Appropriate materials for age, gender, and skills. - Small group training or individual training - In quiet room - Patient to clinician distance should be no longer than 1 ft. Informal Auditory Training - More of a real life training to reinforce skills that is learned from formalized training. - Carried out by family - Improves patient’s confidence and improves motivation.

Auditory Verbal Method - 4 hr/7 day a week approach to the child to help acquire spoken language through listening. - Utilizing aids and implants are critical for this method to be successful (widely used with implants) Communication Strategies Training Programs - Informational brochures in waiting room - Pragmatic approach: used in conjunction with other programs or can be standalone. - Facilitative repoir strategies. Anticipatory Strategies - Often encourages to improve environment and reduce communication breakdowns. - Passive vs. aggressive (blaming others) - Strive for assertive for needs without being passive or aggressive (therapist acts as a coach). Computer Assisted Speech Training (CAST) - successful and widely used today - can work on treatment alone, at home, or alongside therapist. - LACE Who should receive auditory training? - Any individual with hearing loss or deafness is a candidate. - Patients with implants or hearing aids. - Children with prelingual HL, - Children and adults with post-lingual HL will work on higher level auditory tasks. Assessment of Auditory Skills - Ongoing assessment - Assess pre and post treatment - Important to identify specific auditory skills that require treatment. - Testing materials should be selected based upon age, type, and degree of HL and intellectual ability. - Infants and children need formant testing and observation. - Adults more formalized.

Lecture 8: Spreadsheet Assessment and Training Visual Communication 1. Speech reading: a. More than just lip reading, but includes lip reading b. Interpreting facial expressions

c. Watching gestures, posture, movements, and utilizes situational cues. d. *An individual using speech reading must be motivated to use residual hearing. e. In order to distinguish phonemes they need to receive acoustic features of speech. f. Vowels provide intensity and the power of speech g. Consonants provide the intelligibility of speech and have much less intensity than vowels. i. Determined by manipulation of various articulators. *Visemes= Distinctive visual features provided by vowels and consonants due to the placement of the articulators. *Homophomenes= Visually confusing because they look alike (ex: /p/, /b/, /m/) 2. Manual communication: (sign language) visual system of signs created with hand movements. History of Speech Reading - Beginning of 20th century: speech reading was principal method used in aural rehab. It focused on: sensation and visual cues. - Today it is rarely used as the only mode of communication. Today, both auditory and visual cues are present. - Speech reading is part of most aural rehab programs, only with auditory verbal training that speech reading is strongly discourages. Factors that effect speech reading: 1. 50% of conversational speech, words are indistinguishable visually. 2. Looking only provides 40% of information that can be provided acoustically. 3. Familiarity with speaker is important 4. Using facial expressions and rate of speech help. 5. Environment provides contextual cues a. Viewing angle b. Distance (5 ft. from speaker is optimal, no more than 20 ft.) 6. Lighting, picture cues can increase speech reading. 7. Cultural differences 8. Age (elderly process visual info more poor) 9. Gender (females better than males) 10. Intelligibility 11. Motivation 12. Visual acuity and hearing. *Both adults and children benefit from speech reading. -Must wear hearing aids or cochlear implant. -Visual acuity should be tested prior to assessing speech reading ability. Formal Assessment - Presenting syllables, words or stories with visual, auditory, and combined information.

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Can be presented live or presented with a recording. CID, everyday sentence test, is an example of a formal assessment. No standardized way.

Informal Assessment - Clinician can create own assessment but has to keep the environment in mind (good lighting, no distractibility). Speech Reading Training Methods: Analytic Vs. Synthetic Analytic - Focuses on identifying smaller units (phonemes and syllables as key units to identify in a string of words). - Taught to learn vowel/consonant recognition in the form of this training. - Drill work. Synthetic - Focuses on using the context of the sentence to determine the message to understand the meaning. - Key words and phrases are important while giving visual and auditory cues. Continuous Discourse Tracking - A method developed in late 1970s by Defilipo and Scott. - Assessment AND therapy tool. - Patient repeats passages verbatim with auditory and visual cues. - Performance is based on the number of correct words identified and between 72-100 words/minute. - Those who score very low may be candidates for cochlear implants or manual communication. Holistic Approach for speech reading training. - Help to make training more interesting for children and incorporates several methods. - Child sets goals and makes commitments to accomplish them (uses self and clinician evaluation) - Both drill work and real life practice are incorporated. - Child may naturally learn and clinicians can faster that. Computerized Instruction in Speech Reading - popular approach for adults and can be done individually or alongside clinician. _________________________________________________________________________________________________

Chapter 9 Counseling -

A good counselor= a good listener. 90-95% of those with HL are classified as hearing impaired 5% are deaf/profound HL.

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Even smaller subset for Deaf community All receive different approaches to counseling.

In CORE model, consider O (overall participation variables) the psychosocial elements. Also the R (related personal factors). Looking for readiness for change -Difference in counseling for children/families vs. adults. Adults - Impact on self-concept, social/emotional concerns and family concerns. - Cosmetic issues important (stigma of HL) - Grief Cycle (denial  anger  depression  bargaining  acceptance) o Once patient is at point of acceptance they are ready to receive help. - Counseling can help to facilitate adjustment. - Counseling beyond scope of practice? Refer patient to psychologist, etc. - Patient motivation is KEY to any success in treatment o Helping to educate o Change values/attitudes. Terminology - Psychotherapy: Psychiatrists/psychologist o Explores unconscious behavior patterns and ways to alter these behaviors. - Counseling: Develop “here and now” strategies” o Support for particular situation o Many different professions (Auds, SLPs) o Personal Adjustment Counseling  Two way  Patient can clarify their problems and explain their story and take responsibility for listening problems.  Patient can establish goals and plans  Rationale adjustment: about HL and diagnosis  Emotional counseling. o Informational Counseling  One way  Telling patient what we know as clinician  Educate Avoid pitfalls of counseling: - Habituation: “I’ve heard it all before” approach. - Avoid assumptions - Don’t take control (consider patient a partner) - Counseling should be patient centered o Unconditional positive terms

o Empathetic understanding (reflects opinion back) o Short term and focus on solution. Benefits of Counseling - Enhancement of understanding of hearing loss and communication - Better self acceptance - Greater knowledge of how to manage communication difficulties. - Reduce stress and increase satisfaction. - Stronger compliance. Counseling for Children and Families - Grief reactions when child is diagnosed is normal o Dealing not directly with patient, but with parents/families. - Critical to correct incorrect assumptions of HL. - 90% of children with HL are born to hearing parents. - Hearing loss has a devastating impact on language acquisition, speech development, social interactions, communication skills, literacy, and academic achievement. o Often leads to poor self-concept and social isolation/impact on future vocational choices. - Children with prelingual HL are most severely affected - Children with perilingual HL is a similar impact on development - Children with postlingual HL acquired will have the negative social impacts/academic achievement. - Early ID and intervention before age...