Aural Rehab Midterm - CSD 591

Activities related to hearing for ICF

detection, discrimination, and identification of environmental and speech sounds. Comprehension of speech

Resources and services for adults in aural rehab (4)

-Sensory devices (fitting, instruction, troubleshooting)

-Direct training (auditory training, lipreading, A + V training)

-Counseling (informational, psychosocial, support groups, educational, advocacy, assessment of difficulties, referral for services)

-Instruction about communication strategies to enhance communication, availability of resources

Resources and services for children in aural rehab (4)

-Sensory devices (device monitoring and accessory devices)

-Direct training (SLP therapy, AT, AVT), development of auditory skills, sign skills

-Instruction (HL prevention of hearing loss. awareness of dangers of noise, education of D/HH resources and school placement, inservices in schools, advocacy)

-Counseling (family adjustment and support, assessment of listening/hearing difficulties, empowerment for D/HH)

What is aural rehab?

an ecological, interactive process that facilitates one's ability to minimize or prevent the limitations and restrictions that auditory dysfunctions can impose on well-being and communication, including interpersonal, psychosocial, educational, and vocational functioning.

Why is AR needed? (3)

-The degree to which a person with HL has access to the acoustic properties of speech will affect detection, discrimination, and identification of phonemes which together will impact speech recognition and comprehension of spoken language

-speech acoustics and speech cues are available by frequency

-acoustic cues are important for perception

Suprasegmentals

word stress, intonation, syllable stress, prosody - emotion, meaning

Segmental features

consonants and vowels both conveyed by changes in frequency, intensity, and duration of physical acoustic properties

HL in lower frequencies can lead to what?

confusion in vowel identification, voicing, and perception of suprasegmentals and unstressed syllables

HL in higher frequencies can lead to what?

Confusion in manner, place, and detecting or discriminating softer higher frequencies

Auditory deprivation (3)

-a period before children with HL are fit with devices

-Slower language development

-Can lead to brain reorganization that can impact processing of spoken language

-earlier access to devices and intervention associated with early access to the speech spectrum

Two models of AR

Boothroyd model and ICF

Boothroyd model

specifies areas of intervention for AR

-includes sensory management, instruction, perceptual training, and counseling

ICF model

specifies the problem activities and areas of participation that need to be addressed with AR for a particular client

Purpose of ICF model

to have a common language to describe functioning across the globe about health, disability and functioning

Application of ICF to HL

HL can affect daily functions, the activity limitations as a result of HL, can lead to restricted participation in every day life

Purpose of AR

to assist PHL to improve communication function and increase participation in different communicative settings of their lives

Prevalence of APD (4)

-3-5% of school aged children, or 2.5 million children have APD in the U.S.

-twice as likely in males

-true prevalence may be greater due to undiagnosed or misdiagnosed cases

-heterogeneous presentations make diagnosis difficult

Characteristics of APD (14)

-difficulty understanding spoken language in competing messages, noisy backgrounds, or in reverberant environments

-misunderstanding messages

-inconsistent or inappropriate responding

-frequent requests for repetitions

-saying "what" and "huh" frequently

-taking longer to respond in oral communication situations

-difficulty paying attention

-easily distracted by auditory and visual stimuli

-difficulty following complex auditory directions or commands

-difficulty localizing sound

-difficulty learning songs or nursery rhymes

-poor musical and singing skills

-associated reading, spelling and learning problems

-has memory deficits, both short term and long term

How is APD diagnosed? (3)

step 1: observation, screening tools

step 2: in depth formal testing, behavioral measures, standardized tests, electrophysiological measures

step 3: determine specific areas of APD weakness

Special considerations for in-depth test for APD (5)

-normal peripheral hearing

-age: generally after age 7

-Cognitive function: WNL

-Presence of other disabilities: ADHD, ASD not typically tested

-Language competence: Must be assessed prior to APD testing

Multidisciplinary team for APD

SLP, Aud, Psych, Teacher, Parent, PCP

Auditory discrimination training

helps children distinguish the intensity, frequency, and duration of one sound from another

Phoneme discrimination training

Helps children distinguish between speech sounds that make a difference in meaning in a particular language (/p/ vs. /b/) and phoneme-grapheme skills (sound/symbol)

Procedure auditory discrimination (2)

-presentation of phoneme and words using drill like activities (stimuli presented at comfortable listening levels, child asked to point/repeat word)

-Scoring based on percent correct

Minimal pairs approach (4)

-auditory discrimination excercise

-based on distinctive features of opposite sounds within words

-2 words that sound the same except for a single feature (pie/by or cab/cat)

-helps children reorganize and learn that 2 different target sounds causes a change in meaning

Auditory discrimination exercises

-minimal pairs

-rhyme recognition

-initial/final and medial sound discrimination

-blending

Temporal processing (2)

-perception of sound within a restricted or defined time domain

-need to be able to detect differences in time to make meaning of speech. Temporal resolution ability allows us to detect these difference in time. Underlying component of auditory processing capabilities

Gap detection task (6) (RGDT)

-used for temporal processing

-to perceive speech accurately, humans have to be able to discriminate very small differences in the time domain of the speech stimulus - usually less than 10 msec

-listener must indicate when they hear one vs two clicks or tones

-pairs of sounds are presented across freq. with gaps of silence ranging from between 0-40 ms

-Listener is asked to raise one or two fingers based on the number of stimuli

-If child has result > 10 msec on RGDT, may have temporal processing deficits

Dichotic listening (4)

-provides info on the function of L and R hemispheres and the transfer of auditory info between hemispheres

-Presenting stimulation or competing messages to each ear in simultaneous manner

-binaural integration requires the participant to repeat back what is heard in both ears

-Binaural separation involved the repetition of stimuli presented to one ear while the stimulation of the opposite ear are ignored

Ear advantage scores on dichotic listening tasks (4)

-ear advantage is an indicator if possible hemispheric dominance for language and neurolocially-based language/learning disorders

-The mathematical difference between the right ear and left ear raw scores is used to indicate ear advantage. Positive value = right ear advantage (left hemisphere dominance) Negative value = left ear advantage (right hemisphere dominance)

-most children up to age 10-12, with typically developing auditory systems, demonstrate some RE advantage, over age 10-12 with typically developing auditory systems, demonstrate no significant advantage

-Children with APD will present with very large RE advantage compared to same aged peers (LE weakness)

Why is there often a right ear advantage on dichotic listening tasks? (2)

-The signal travels directly from the RE via the contralateral pathway to the left hemisphere, "the language center"

-the signal travels indirectly from the LE to via the contalateral pathway to the right hemisphere and then crosses corpus collosum to the left hemisphere

Monaural low redundancy (5)

-filtered words

-FW assesses the ability to process distorted speech by presenting monosyllabic words low-pass filtered at 750 Hz (achieved by filtering out high freq., results in a degraded speech signal)

-The child is instructed to "say the word..." they hear

-ability to interpret degraded speech using auditory closure skills (requires filling in missing element of speech)

-Scoring in percent correct (low scores suggest that child may have difficulty attending to and understanding speech in situations in which part of the acoustic signal is distorted or missing)

What are the 4 key auditory areas of AP that need to be assessed and what test is used for each?

auditory discrimination (phoneme/word discrimination), pattern temporal resolution (Gap detection), dichotic speech test (dichotic digits/word/sentence), monaural low redundancy (filtered words)

Medical vs social model

medical model puts emphasis on needing to "fix" the individual to fit in with society, whereas social model emphasizes that society needs to change so the individual can fit in

deaf (3)

-deafness perceived as impairment

-not using sign language as primary form of communication

-integrating predominantly with the hearing community

Deaf (3)

-deafness as socio-cultural perspective

-sign language as primary way of communication

-immersed in Deaf culture

5 domains of Deaf culture

-language

-behaviors

-traditions

-values

-identity

example of language domain of Deaf culture (5)

-ASL

-no universal sign language

-grammar differs from spoken English (time, topic, comment, verb)

-whole body used to convey meaning/emotion

-using sign language with infants does NOT negatively affect language development

example of behavior domain of Deaf culture (5)

-maintain eye contact

-Direct/blunt

-To gain attention (flick lights, use touch, stomp ground or table, walk through conversations)

-applause by waving hands

-Proximity to speaker

example of traditions domain of Deaf culture (3)

-Art (theater, dance, poetry, music, actors)

-school for the Deaf

-Deaf history month-April

example of values domain of Deaf culture (6)

-visual transmission of information

-technology

-Deaf rights

-collectivism

-effective communication

-socialization

example of identity domain of Deaf culture (6)

-Lived experiences vary

-Bicultural

-Regional languages

-Comorbidities

-Black ASL

-Intersecting identities

What can we do as SLPs and audiologists to address Deaf culture? (8)

-Recognize and respect individuals from Deaf culture

-Promote equity with intentionality

-Ensure effective communication (use interpreters, advocate for interpreters)

-Access state resources through commission for Deaf/Hard of Hearing

-Know how to work with an interpreter

-Explore communication methods

-Provide fair, unbiased information and recs to parents about sign language

-familiarize self with issues/vocabulary around language acquisition for children who are Deaf

How does auditory development occur? (4)

-Process of perception that is influenced by innate genetically programmed changes in A & P and auditory experience and exposure

-Anatomical structures are intact by 2nd trimester, there is stimulation prior to birth

-speech develops naturally because we have auditory access to all speech sounds

-Typical child needs one year of active listening before using spoken words

Auditory-verbal link input

auditory perception and auditory processing

Auditory-verbal link output

speech and spoken language organization and speech and spoken language production

Typical speech productions errors for low frequency loss

-poor prosody, problems with nasalization, deletion of syllables, confusion between nasal and plosive phonemes, voiced and voiceless consonants, and discriminating vowels

Typical speech production errors for mid frequency loss

omission of unstressed morphemes, neutralization or centralization of vowels

Typical speech production errors for high frequency loss

demonstrate omission and/or distortion of fricatives, omission of final consonants, distortion or substitution of stops

Typical language errors for low frequency loss

problems with verbs (-ing is at 300 Hz), irregular past tense, prepositions

Typical language errors for mid frequency loss

difficulty with articles (a, an, the), conjunctions (for, and, but, or, yet, so...), pronouns (I, you, he, she, we, they, him, her, he, she, us, them)

Typical language errors for high frequency loss

difficulty with verb endings (/t/ past tense /ed/), /s/ markers, irregular past tense (eat vs ate), and ability to understand multiple meanings, vocabulary, grammar, and connected discourse

Erber's hierarchy of auditory skills

easiest skill to hardest skill - detection (hear), discrimination (differentiate), identification (label), comprehension (process, understand, respond)

Auditory training (3)

-the systematic presentation of auditory stimuli where individuals are taught to make perceptual distinctions about sounds

-process aimed at improving the auditory skills of individuals with HL through structures and repetitive listening exercises

-repetition of targeted skills using a structured format, detection, discrimination, identification, comprehension

What does AT consist of?

exercises or listening trials where the person listens to a large number of presentations of speech sounds, males a judgement after listening to each presentation such as identifying the sounds heard, receives feedback after each attempt about whether the judgement was correct or incorrect

Analytic activity

emphasizes acoustic content; bottom up; focuses on acoustic signal

Synthetic activity

emphasizes integration, attention, context. Focuses on holistic meaning of auditory signal; top down

4 design principles to create an AT session

selection of auditory skill level, stimuli, activity type, and difficulty level

bottom-up processing

taking sensory information and then assembling and integrating it. (what am I hearing?)

Top-down processing

using models, ideas, and expectations to interpret sensory information. (is that something I've heard before?)

Vowels (4)

-more intensity thus more audible

-most vowels have lower frequency acoustic energy

-most vowels at 45 dB

-primarily made up of 2 critical "formants" (bands of energy)

Formants (5)

-bands of energy

-F1 - first frequency that makes up vowel. 500-1000Hz

-F2- higher frequency. 1200-2500 Hz

-F1<1000 Hz

-F2 >1000Hz

Consonants

-softer

-More high frequency information so less audible, more trouble

-voiced consonants all louder than voiceless

Criterion for moving to next level in AT sessions and how to change difficulty (2)

-If only getting 20% correct, then activity is too difficult. If achieving 100% then activity is too easy. Don't wait until obtain 100% correct. 80-90% typical level for competency

-vary response set size (small = easy, large = hard), stimulus similarity (more = easier, less = harder), contextual support, listening conditions (noise vs quiet), distance (close vs far)

Steps for creating AT treatment plan (4)

-Select skill, stimuli unit, mode

-Adjust difficulty depending on progress

-Plan to work on more than one type of auditory training task

-Anticipate amount of training needed (more complex tasks require additional training. Adults can focus on task up to 30 minutes, children 15)

Types of auditory skills

detection, discrimination, identification, comprehension

Type of stimuli units

syllable, word, phrase, sentence, connected discourse

Types of modes of training

auditory, AV, visual

Key differences between AT and AVT (7)

-Overall aim for both AT and AVT is to improve listening skills

-Specific focus differs

-AT focuses on improving sounds perception and discrimination

-AVT focuses on developing spoken language through active listening

-AVT emphasizes rely solely on auditory cues to understand language, minimizing the use of visual cues like lip-reading

-AT broader population application (AT is used with individuals with HL including adults, AVT is typically used with young children with severe HL and either HAs or CIs)

-Parental involvement is a key feature of AVT where parents actively participate in the therapy process to facilitate their child's listening development at home.

5 key principles in AVT

-use a framework of auditory skill development to determine performance, goals, and monitor progress

-Calculate hearing age and compare with normal auditory speech and language milestones

-HA and CI checks using ling sounds to monitor auditory access

-Use parental and teacher questionnaires to determine needs and goals

-Include essential strategies for working with children with HL

Hearing age

used to indicate the child's length of time with CI or HA. Calculated by subtracting age child received HA or CI from chronological age

Learning to listen sounds (3)

-sounds associated with objects

-start with animal sounds (cat, meow)

-common phrases (bye-bye, goodnight, all gone)

Acoustic highlighting (3)

-Make words and phrases we say more salient

-Brain is always looking for pattern and things that are different to catch attention

-Can emphasize with volume, speech, repeating

Auditory sandwich (5)

-Auditory first strategy

-Tell (give direction using only words)

-Wait (count 7-10 seconds in your head, looking at them for a response)

-Show (point, make a gesture, or show the thing you are talking about)

-Tell (give the direction again using only words)

Auditory environment (3)

-Sound (quiet, assistive technology in noisy)

-Location (Parents, teachers, and/or therapists sitting next to child on the side of CI or HA, if bilateral in front. Sitting directly across from child & using an acoustic screen)

-Limit screen time (in households with high rates of electronic media exposure there were fewer conversational turns. Conversational turns demonstrate stronger linguistic outcomes)