FOAR M11-M13 Exam

ear canal

Opening allowing sound/speech stimuli to enter ear and vibrate tympanic membrane

tympanic membrane

Membrane attached to Malleus (1 of the 3 ossicles)

ossicles

smallest bones in our body (Malleus, Incus, Stapes); stapes attaches to cochlea via oval window

cochlea

Inner/Outer Haircells convert mechanical energy from stapes to electrochemical, sending implus to auditory nerve via spiral ganglion cells

vestibulo-cochlear nerve

Receives tonotopic/frequency specific input from spiral ganglion cells transfers to cochlear nucleus

cochlear nucleus

Auditory processing begins here (timing/level cues); then sent to superior olivary complex

superior olivary complex

Where binaural processing begins; then sent to lateral lemniscus

lateral leminiscus

sound idenfitication / localization; then sent to inferior colliculus

inferior colliculus

Primary site of convergence/integration before sending further up to the cortex

medial geniculate body (thalamus)

Encodes visual with auditory stimulus; sending to auditory cortex (left hemisphere)

auditory cortex

Encodes all sounds/speech stimuli for processing/understandin

central pathway (ECOLIMA)

E- eight nerve

C- cochlear nucleus

O- superior olivary complex

L- lateral lemniscus

I- inferior colliculus

M- medial geniculate body

A- auditory cortex

central auditory processing disorder (CAPD)

A modality specific disorder related to deficits in localization, lateralization, discrimination, temporal processing, organization, and poor preference with competing or degraded auditory signals. Observed deficiency in one or more.

(C)APD involves a neural processing deficit of auditory stimuli that may co-exist with, but is not the result of, dysfunction in other modalities

Three main types- Developmental (C)APD, Acquired (C)APD, Secondary (C)APD

case history for CAPD

Chronic ear infections

Medical management

Pass/Refer NBHS

Full-term/Premature NICU Stay

Eye/Heart/Kidney Diagnoses

Family history of hearing loss

Concerns for speech/language/hearing

Speech services

Other diagnoses Milestones

Head injuries

Concussion

TBI

signs and symptoms of CAPD

typically normal hearing

Complaints of trouble hearing in noise

Trouble seperating noise from speech

Difficulty following multi-step directions

AUDITORY MODALITY ONLY

Poor reading skills Poor comprehension

Spelling problems Inappropriately responses

Poor listening skills

Frequently asking for phrases to be repeated

“I can hear you but I do not understand what you said”

co-morbid/misdiagnosis of CAPD

ADHD/ADD:

Frontal lobe involvement: difficulty regulating impulsive responses, expressive language, difficulties in tolerance fading memory testing

Disorganization (planning/sequencing) common reversals shown on testing

Dyslexia:

Integration difficulties both auditory and visual (posterior corpus callosum)

Severe reading and spelling problems

tympanometry (minimal test battery in evaluation)

Rule out any middle ear pathologies

acoustic reflexes (minimal test battery evaluation)

Rule out retrocochlear pathology and test integrity of auditory nerve

DPOAE’s (minimal test battery evaluation)

Determine health of organ of hearing the cochlea

auditory brainstem response (MTB evaluation)

Assess brainstem and cortical level integrity

complete audiological evaluation (MTB)

Pure tones (Air and Bone), speech recognition, word recognition

processing tests (MTB evaluation)

Dichotic tasks (communication between hemispheres) and temporal processing tests

minimal test battery

Medical model

Does not address educational concerns

Rule out or in (C)APD is present

complete audiological evaluation (bellis/ferre model)

. Pure tones (Air and Bone), speech recognition, word recognition,

auditory pattern/temporal ordering

Examines temporal processing, sequencing/ordering ability

binaural integration (bellis/ferre model)

Examines ability to respond to competing signals to both ears

binaural separation (bellis/ferre model)

Examines ability to respond to stimulis in one ear while ignoring the other

auditory discrimination (bellis/ferre model)

Examines ability to differentiate between stimuli

bellis/ferre model subtypes

Auditory Decoding Deficit

Prosodic Deficit

Integration Deficit

auditory decoding deficit

“True ”(C)APD

Poor performance in right ear only conditions

Dichotic Digit Test Binaural integration weakness

Weak vocabulary

Weak reading skills

Weak spelling skills

Improvement with visual aids/support

prosodic deficit

Difficulty perceiving and recognizing nonspeech stimuli Weak left ear on dichotic tests

Weak binaural integration

Weak binaural separation

Good speech-in-noise

No decoding deficit

integration deficit

Inter-hemispheric skill weakness

Drawing

Understanding dictation

Multimodal tasking

Weak left ear results on dichotic listening tasks

Poor non-verbal test scores

Weak sound localization ability

Weak binaural integration

Weak binaural seperation

complete audiolgical evaluation (buffalo model)

Pure tones (Air and Bone), speech recognition, word recognition, DPOAE’ s

decoding (buffalo model)

Pure tones (Air and Bone), speech recognition, word recognition, DPOAE’ s

decoding (buffalo model)

Examines ability to identify, manipulate, and remember phonemes

tolerance-fading memory

Examines short-term auditory memory and speech in noise processing

integration (buffalo model)

Examines inter-hemispheric information transfer

organization (buffalo model)

Examines organization, planning, and sequencing ability

decoding

Weak oral reading skills

Weak word accuracy

Weak spelling skills

Quantitative Signs

Weak right competing and left noncompeting

Staggered Spondaic Word Test (SSW)

Qualitative Signs

Delayed Response

Quiet Rehearsal

Preseveration

tolerance-fading memory

Second most common type of (C)APD

Expressive language difficulty

Difficulty inhibiting impulsive responses

Quantitative Signs

Ordering difficulty on SSW (reversals)

Qualitative Signs

Quick Responses

Smush Response

See shore outside

see shout side

Repeats carrier phrase “Are you Ready ”

qResponds to carrier phrase

integration

Most severe type of (C)APD

May require more than 1 APD therapy

APD therapy is 12 weeks

Severe reading/spelling problems

Difficulty integrating visual/auditory information Commonly diagnosed with Dyslexia Quantitative Signs Type A on SSW

Severe peak of errors in one particular column (Left competing)

Indicates difficulty in interhemispheric transfer

Qualitative signs

Extreme delays

fisher auditory problems checklist (questionnaire)

Normative data kindergarten-6th grade. 25 questions

children’s auditory processing performance scale (CHAPPS) (questionnaire)

Parent/Teacher 36 questions

buffalo model questionnaire- revised

39 questions

children’s auditory processing performance scale (CHAPPS)

Six listening situations

Ideal

Quiet

Attention

Memory

Noise

Multiple inputs

Compares child to age matched peer

Scoring +1 less difficulty than others -5 cannot function in situation

Range +36 to -180

At risk for (C)APD -12 to -180

buffalo model questionnaire-revised

Categories

Decoding

Noise

Memory

Tolerance-Fading

Memory

Integration

Organization

General

5 years to 69 years

Administer

Prior to evaluation

During therapy

After therapy

screening test for auditory processing disorder (SCAN)

5-12 years of age SCAN-3: C and 13 to 50 years SCAN-3: A

tests of auditory perceptual skills- revised (TAPS-R)

Completed by Speech-Language Pathologists

auditory skills assessment (ASA)

Asses skills for children 3.6 to 6.11 years of age

screening test for auditory processing disorder (SCAN)

SCAN-3:C

5-12 years of age

SCAN-3:A

13 to 50 years of age

Includes

Three Screening measures

Gap Detection

Auditory Figure-Ground

Competing Words

Four Diagnostic measures

Filtered Words

Auditory Figure-Ground

Competing Words

Competiing Sentence

3 Supplementary

Auditory-figure ground +12dB SNR or 0dB SNR

Time-Compressed Sentences

tests of auditory perceptual skills- revised (TAPS_R)

Children 4-18 years of age

Measures

Processing

Discrimination

Interpretation

Provides insight to perceptual auditory ability

Does not pinpoint underlying (C)APD difficulty

Used to rule in/out possibility of (C)APD

auditory skills assessment (ASA)

Children 3.6 -6.11 years of age

Speech Discrimination in noise

+6dB SNR

Mimicry

Blending Rhyming awareness

Tonal discrimination

Tonal patterning

buffalo model (treatment)

12 sessions typically 12 weeks

compensatory strategies (treatment)

Enhance listening skills, communication, memory, social skills

environmental/audio modifications

Manipulating the environment to work better for the individua

buffalo model (T)

Direct skills remediation

Therapy based on results obtained from testing and (C)APD subtype.

Decoding

Phonemic synthesis

H and friends

Tolerance-Fading Memory

Speech-in Noise

Desensitization Training

Anxiety/tension hearing in noise

Short-Term Auditory Memory Program (STAMP)

Digits

Words

Starts at 3 then increases to 5

compensatory strategies

Advocating for yourself

IEP/504

Organizational skills

Graphic organizers

visual aids

visual cues

Active listening

Comprehension check

Have written/printed copies of lesson

environmental/audio modifications

Preferential seating

Front of class

Away from door

Away from class pet

Not under HVAC

Away from windows

FM system

Speaker on desk

Low gain hearing aids

FM system

ROGER System

Sound tiles to reduce reverberation

Carpet/rugs to reduce reverberation

speech evaluation

●Voice

●Articulation

●Intelligibilty

voice

breath control

pitch

volume

rate

prosody

articulation

Test designed for children with hearing loss include:

○The Phonetic Level and the Phonologic Level Speech Evaluation

○The CID Phonetic Inventory

○The Speech Intelligibility Evaluation ○The Beginners’ Intelligibility Test

●Often, conventional articulation tests are used, such as: ○Goldman–Fristoe Test of Articulation ○ Test of Minimal Articulation Competence (T-MAC; Secord, 1981).

intelligibility

Intelligibility refers to how well the speaker is understood. You can use a variety of samples from single words, functional Phrases, paragraph reading or conversational samples

● Ways to assess:

○ Word –Identification Approach: unfamiliar listener transcribe what they think child said

○ Percent of words understood: transcribe a speech sample and calculate percentange.

○ Intelligbility in Context Rating Scale (ICS) (McLeod et al, 2012) it's a 7-item rating scale that you can give to families/caregivers of preschool and school-aged children, has been translated into a number of languages, available in two formats: monolingual or bilingual (language + English);

speech reading

● The Craig Lipreading Inventory -speech read single words and identify these words from a closed-set of pictures

● Utley Sentence of Lipreading which is an open-set test of functional, unrelated sentences with language controlled to the third grade leve

language evaluation

Vocabulary

● Semantics

● Language Processing

● Syntax

● Questions

● Figurative Language

● Personal Information

expressive vocab

○ EXPRESSIVE VOCABULARY TEST (EVT)- speech/printed stimuli for single word vocabulary

○ THE WORD ADOLESCENT TEST (WORDA)* - expressive vocabulary/semantics

○ EXPRESSIVE ONE-WORD PICTURE VOCABULARY TEST-R/-3 (EOWPVT-R/ EOWPVT-3)-obtains an estimate of signed/fingerspelled vocabulary skills by asking her/him to name pictures with a single-word response

receptive vocab

○ CAROLINA PICTURE VOCABULARY TEST (CPVT)- signed single word vocabulary

○ PEABODY PICTURE VOCABULARY TEST (PPVT-4)- speech/printed stimuli for single word vocabulary ○

Receptive One Word Picture Vocabulary Test (ROWPVT) -assesses receptive single-word vocabulary in the oral/printed modes

sematnis tests

The TEST OF RELATIONAL CONCEPTS - D/HH (TRC-D/HH) understanding of basic concepts of dimensional adjectives and spatial, temporal, and quantitative words through a multiple choice picture format. “The accompanying Test of Relational Concepts: Norms for Deaf Children is the only child-concept test on the market with norms for deaf children.”

● The WORD-4 ELEMENTARY assesses expressive vocabulary and semantics. Associations, Synonyms, Semantic Absurdities, Antonyms, Definitions and Multiple Definitions.

● The WORD-3 ADOLESCENT TEST assesses understanding of “language and word meaning, using common as well as unique contexts”. The four subtests assesss semantic and vocabulary used in the classroom as well as language used in everyday life. - BRANDS, SYNONYMS, SIGNS of the TIMES, DEFINITIONS

language processing tests

Language Processing Test – R (LPT-R) - assesses semantic and language processing skills. These skills are essential for attaching meaning to information, for word retrieval, correct word usage, and retention of information. ( Semantic Hierarchy: labeling, stating functions, associations, categorization, similarities, multiple meanings, and attributes)

● Test Of Word Knowledge (TOWK) - assessses receptive and expressive relational and metalinguistic aspects of vocabulary and semantics.

syntax tests

Rhode Island Test of Language Structure (RITLS) Assesses comprehension of signed English syntax using a three-picture, multiple choice format

● Test of Syntactic Abilities-Screening (TSA) Assesses recognition and comprehension of written English syntax

● Structured Photographic Expressive Language Test–III. Assesses the use of inflectional MORPHOLOGY (plurals, possessive nouns, verb tense endings), VERB FORM (present progressive, regular and irregular, past, future, verb tense, participles, copulas) PRONOUN USAGE, (subject pronoun, possessive pronoun, reflexive pronoun), and SYNTAX (negative, conjoined sentence, Yes/No questions and ‘Wh’ questions).

● Test of Written Language (TOWL-4) Assesses expressive spontaneous written English

questions test

informal questions; asses spoken-signal questions

figurative language tst

informal assessment: asses understanding of idioms, similes, personifications, metaphors

personal info test

INFORMAL PROBES: Assess ability to document personal information – at the HS level include forms with items that they may need to fill out in the future.

reasons for literacy dificulties

A restricted language system.

● Unfamiliarity with the meaning of the constituent words and the sentence structures therein

● No understanding of words’ relations to other words

● No semantic network that allows activation of possible words in the child’s vocabulary as the child progresses through a text

● No auditory basis for mapping sound to print. Reading entails acquiring the alphabetic principle, which is knowing how to translate graphemes (orthography) into corresponding sounds and words so they can “sound out words” for sound–print mapping.

● Phonologic awareness allows children to recognize and work with parts of words and sentences.

● Phonemic awareness, which is a subset of phonologic awareness, allows them to focus on individual phonemes and manipulate them.

● Deficits in experience and world knowledge

literacy

●Reading delays are common; many may not achieve the fourth-grade level even by adulthood (limited language; may have trouble mapping sound to print)

●Writing samples often contain syntactic errors such as omission of articles, inappropriate use of pronouns, and omissions of bound morphemes (e.g., ‘s; ‘ed). Preponderance of subject-verb-object sentences. Narrative structure may be aberrant (e.g., no clear beginning, middle, end).

●Cochlear implants improve the prognosis

example of writing sample

A girl name Tiffany. She walking by the stroe and she saw a macigi sleding and she went into the store and buy the macigi sleding and she can’t wait to go sled down the hill. When she finish buy the sled. She was in a hurry. When she got home she put her snowpant on, hat, boots, mittens, scarft. And ran up the hill and she try to sleding down.

literacy evaluation

Assessing literacy skills is important for at least two reasons:

• Results can inform decisions about classroom placement and need for support services

• Results can show a child’s strengths and weaknesses, and help teachers target efforts

reading skills assessed

○Reading and language comprehension

○Phonology

○Syntax and semantics

○Decoding, phoneme awareness

○Alphabetic principles

○Letter knowledge

○Concepts about print

writing skills assessed

○How a child is developing, with comparisons over time. ○One assessment asks children to write a paragraph or short narrative about a topic, measured by a scoring rubric that measures

• Organization

• Content

• Language use

• Vocabulary use

other means for assessing writing skills

●Documenting the number of sentences and length of composition

●Evaluating the complexity of syntactic forms used

●Counting, analyzing, and categorizing the errors

●Performing a quantitative analysis of the various parts of speech and types of transformational grammatical structures included

●Assessing sentence awareness by computing the percentage of sentences that were fragments or run-ons

●Counting the number of function words that are correct, incorrect, or omitted

counseling

Understand own hearing loss and dealing with some of the consequences

psychosocial support

Address psychological and social difficulties resulting from hearing loss

assertiveness training

Learn to state negative and positive feelings

story and narrative theory

ask questions to patient to have them talk about a personal story

while collecting story

Effective clinician behaviors during narrative therapy include:

• Active listening;

• Brief verbal affirmations (I see, I understand);

• Silence;

• Empathy;

• Non-verbal behaviors.

counseling

Understanding of hearing loss and effects

• Acceptance of hearing loss

• Management of communication difficulties

• Decreased stress-related issues

• Increased satisfaction with aural rehabilitation progress

• Increased self-motivation

• Continuation with aural rehabilitation plan and hearing aid use

informational counseling

• Inform patient and/or family about hearing loss

• Present informally as a dialogue

• Use easy-to-understand language

• Use explicit categorization

• Categorize pertinent information to discuss

personal adjustment counseling

• Focus on adjustment and acceptance

• Cognitive approach

• Modify thought process

• Behavioral approach •

Modify behavior

• Affective approach

cognitive approach

• Rational Emotive Behavior Therapy (REBT)

• Identify activating event or adversity

• Evaluate event

• Identify consequences of event

• E.g., does not want to wear hearing aids

• Dispute negative feelings

• Create effective action

behavioral approach

• Behavior can be unlearned

• Desensitization

• Reduce negative reaction through repeated exposure

• Identify physical systems of stress

• Introduce relaxation techniques

affective approach

• Focus on feelings

• Find congruence with self

• Use honest, person-centered approach

• Use unconditional, positive regard

• Client knows self best and can overcome feelings

• Employ empathetic understanding

• Use reflection and clarification point-of-view

acquiring counseling skills

Take a counseling course, either in graduate school or in a continuing education program.

• Role-play patient interactions with your classmates

. • Engage in standardized patient scenarios, where trained actors portray the role of patients..

• Other ways

: • Read case studies.

• Watch videotaped sessions of real counseling sessions

. • Seek feedback from faculty observers after your own real counseling sessions

. • Attend lectures about counseling.

• Perform reflective journaling, where you reflect on your own counseling experiences.

psychosocial support

Alleviate hearing-related stress, including:

• Stress in understanding speech

• Adjusting to being person with hearing loss

• Adjusting to society’s reaction to self

• Feeling inadequate • Feeling isolated

• Having negative self-image

consequences for freqeuent communication partners

• Feelings of frustration regarding communication difficulties

• Reduced talking and joking

• Spouses initiating AR

• Spouses reporting increased volume levels, repetition, and serving as interpreter

• Family accommodations

support paradigm

• Learn how hearing loss impacts life

• Recognize negative perceptions of hearing loss

• Change self-perceptions to gain self-confidence

• Treatment conducted in small groups

model

problem identificaiton (setting and objective) → problem exploration→ problem resolution

problem-solving model

• Learn how hearing loss impacts life

• Recognize negative perceptions of hearing loss

• Change self-perceptions to gain self-confidence

• Treatment conducted in small groups

problemm resolution

• Define desired outcome of objective

• Identify possible solutions to problem

• Select solution

• Try using solution

• Evaluate solution

• Modify as needed

assertiveness training

• Enhance communication between person and communication partner

• Identify hearing loss to others

• Request modification to environment

• Communication partner facilitates understanding of message

• Positively reinforce communication partner