Aural Rehabilitation Final 

Speechreading

Evaluation

Test Types
  • For children: test of child speech reading (ToCS), Gist Test, Children’s Audio Visual Enhancement Test (CAVET)
  • For adults: CUNY sentences, UTLey sentence test, Denver Quick Test, recorded materials
Stimuli Presentations
  • For profoundly Deaf: HA or processor turned off
  • For HoH: mouth words silently or use recorded stimuli with no sound
    • Live stimuli advantages: more personal, therapist can adjust level of difficulty on the spot, therapist can monitor interest and frustration
    • Recorded stimuli advantages: more consistent baseline and post Tx measures, client can work at own pace, independently, or at home

Perception

Clear Speech
  • found to improve speech reception by 11 to 34%
  • How to use:
    • Prosody, intonation, and stress to emphasize key words
    • Use meaningful pauses and clarify message
    • Speak slowly and clearly
    • Articulate all consonants and vowels are precisely as possible without over exaggeration 
    • Make word boundaries clear
Redundancy
  • Redudant cues include visual and auditory cues
  • Homophones: words or phrases that look alike on the lips. May be spelled and sound very different
  • McGurk Effect: speech sounds are often miscategorized when auditory cues in the stimulus conflict with the visual cues from the speaker’s face.
    • Illustrates audiovisual integration, redundant cues in speech perception, and top down processing
Visemes
  • Consonants: phonemes with the same place of articulation (voicing/manner differences)
    • Hierarchies of Difficulty:
    • consonants produced with front articulators are easiest to see
    • visual discrimination between consonats is easier when place differs greatly
    • initial consonant discrimination is easier than medial or final
  • Vowels: visual distinctions between vowles including lip rounding (spread vs rounded) and jaw height (high vs low)
    • Hierarchies of Difficulty: easiest when lip rounding/spread is greatly different
Neighborhood Density
  • Auditory: words from sparser neighborhoods are recognized more quickly than words from denser neighborhoods
  • Visual: the word “fat” is in a dense neighborhood with many homophones and similar looking words. The word “gulp” is in a more sparse neighborhood with no exact homophones but some similar looking words
  • Auditory/Visual: for the words “fork” and “fish” auditory only and visual only neighborhood densities are similar. They have different intersection densities. Using redundant cues provided by both auditory and visual input, FISH is easier than FORK

Communication Strategies

Goal: compensate for the effects of elevated hearing on interpersonal communication

Candidates: all clients with elevated hearing who use spoken language

Assessment

Goals
  • to determine the need for communication strategies by assessing conversational fluency and style, including the use (or lack of use) of communication strategies
  • to determine the need for counseling by assessing impact of elevated hearing on individual’s activities and participation, given context of their life
Methods
  • Informal: unstructured conversion or with patient alone or with significant other or HoH individual
    • Quantify Mean Length of Turn (MLU): count # of words or amount of time both conversational partners speak/# of turns
    • Near equal MLT for both partners is optimal
    • Count number of communication breakdowns
    • Quantify client’s use of repair strategies
    • Ask outside observers to rate client’s communication effectiveness
  • Formal: structured communication assessments and questionnaires

Facilitative Strategies

Enviornmental
  • Visual: comfortable, bright lighting that illuminates face of the communcation partner; optional viewing angle, distance 3-6ft from partner
  • Auditory: reduce background noise, reduce reverberation, HoH sit facing wall in noisy place
  • Physical Comfort: find a comfortable place that will not add stress
Patient
  • uses counseling techniques to help client develop self confidence and physical wellbeing
  • prepare for communication strategies
  • learn to advertise
  • encourage patients to discuss and role play possible outcomes
Partner
  • elicit clear speech from communication partners with instructions

Repair Strategies

Receptive
  • Rephrase, Elaborate, Request Topic, Confirm
Expressive
  • talker recognizes there has been a misperception, often by puzzled look from communication partner. Repeats message verbatim or with new information
    • Non specific: what? huh? most common, least effective
WATCH
  • Watch the talker’s mouth
  • Ask for clarification
  • Talk about your hearing loss
  • Change the situation
  • Healthcare knowledge (or helpful gestures)

Speech/Language/Literacy

Speech of Deaf Speakers

Respiration
  • basis of all speech production -- probelm with respiration and voicing affects everything else
  • respiration may be normal for non speech activities, but inefficient airflow for speech
    • Poor biomechanical resistance at larynx
    • Poor biomechanical resistance at supralaryngeal articulators
    • Unintended, extraneous emissions of air/sound
  • Vocal Pitch: failure to maintain even pitch, abnormally high pitch
  • Intensity: too loud or too soft, inability to adjust level for different noise conduction
Suprasegmentals
  • Pauses: due to need for air or effortful articulation, rather than to add information
  • Rate: often slower, more effortful
  • Stress: poor or no use of stress may be from unfamiliarity bc it is mostly an auditory event
Articulation
  • Reduced or poor articulation, careful placement of articuulators learned from speech therapy
Consonants
  • Consonants produced with front articulators are easiest to produce in terms of place but not manner
    • Voicing errors
    • Nasalization and other manner errors
  • Plosives are often explosive, contributed to wasting air
  • Back consonants /g/ /k/ /h/ are hard to see
  • /r/ is often distorted
  • /s/ is often produced as a /t/ or omitted entirely
Vowels
  • Vowels are more intelligible than consonants becuase they are easier to produce, hear, and more acceptance of different vowel productions by listeners
  • Tendency to move jaw to produce different vowel sounds bc jaw movement is more visible than tongue
  • Tongue body does not move forward and back as much as typically hearing speakers
  • Vowels may be neutralized or dipthongized
  • Nasalization: hyper or hypo nasal speech because VP port is noat a visible articulator, accurate VP port manipulation is different without auditory feedback
  • Prolongation: vowel sounds are prolonged

Language of Deaf Speakers

Form (Syntax)
  • overuse of simple subject-object-verb structure
  • limited use of complex sentences, adverbs, prepositions
  • unusual word order
  • omission of articles
  • omission of plural markers
  • tense problems
Content (Semantics)
  • concrete, restricted vocabulary
  • restriced use and understanding of idioms
    • parly due to lack of exposure (eavesdropping: incidental learning. Important for word knowledge, idioms, humor, etc.)
Pragmatics
  • communication breakdowns may lead to maladaptive strategies
  • turn taking, topic maintence difficulties
  • lack of eavesdropping can affect pragmatics
  • children who grow up with ASL may have difficult pragmatic/cultural style

Litearcy

Reading
  • Deaf children attain avg 4th grade reading level
    • limited phonological awareness
    • less early exposure to books and reading
    • limited eavesdropping
    • reduced word knowledge
    • limited exposure to idioms
    • over emphasis on spoken language, less time for reading and writing isntruction
    • improvement with CI
Writing
  • same deficits as form and content of spoken language are common in written language

Assessment

Language
  • formal and informal -- catalog forms and vocabulary in client’s repertoire
  • language errors or limitations can contribute to intelligibility
  • if intelligibility is a problem, determine if child needs therapy in articulation, language, or both
Speech Production
  • Formal Tests: evaluation should use formal tests and tasks
    • Imitate words or short phrases
    • Read a passage at the appropriate reading level Relate to a story from a set of pictures (can also be used to evaluate language)
    • Spontaneous speech sample during play or conversation (can also be used to evaluate language)
  • Recorded Sample Evaluation
    • phonetically transcribe results and catalog errors
    • have naive or familiar others listen and determine rate of intelligibility, write what they hear, and phonetically transcribe what they hear

Therapy

Speech and Language
  • Educational method/setting affects how speech and language therapy is conducted for Deaf children (TC, bilingual-bicultural, cued speech, LSL)
  • In most auditory/oral school based programs, sounds are associated with letters, displayed on charts, constantly available, bombarded and reinforced in order to support phonemic awareness and to tie spoken to written language
    • similar to typical classroom setting
Speech Therapy
  • Breath control exercises are fundamental
  • Articulation practice with breath control
  • Production of child’s name
  • High but realistic expectations for “correct” pronunciations
  • Working on speech production when there is little or no hearing:
    • Speech as a visual phenomenon : therapy with speechreading; informal imagery and visual cues
    • Speech as a physical phenomenon: tactile, kinesthetic feedback
    • Voiced vs voiceless: hand on throat
    • Nasals: finger on side of nose
    • Production of stops vs constituents: difference of breath
Language Therapy
  • emphasis on storytelling, reading, awareness of written language

Synthetic Training

Redundancy

  • when client needs help with synthetic exercise, you can repeat stimulus more slowly or prompt with redundant cues
    • knowledge of language strcture (syntax)
    • knowledge of vocab (semantics)

Sabotage

  • purposefully set up a difficult condition for client to encourage use of desired communication strategies (facilitative or repair)

Background Noise

  • makes any task more difficult -- client can practice in this condition or can practice facilitative strategies (asking partner to turn down noise or move to a different location)

Hierarchy of Difficulty

Fill in the blank phrases
  • practice speech perception (task can be auditory, visual, or both)
  • client has printed sentences, clinician produces entire sentence, client must fill in missing words
Gap sentences
  • Client has printed materials
  • Clinician produces the entire sentences
  • Client must fill in the blank
  • Harder tahn fill in the blank bc less info is provided
Topic related sentences
  • Clinician and client agree on a topic of interest
  • Clinician presents a phrase or sentence about the agreed upon topic in the condition or manner appropriate for current goals (visual/auditory/both)
  • Client has no printed info, but knows topic
Discourse Tracking
  • Clinician reads aloud from material that is appropriate for client’s age and interests, one phrase or sentence at a time
  • Client’s must repeat verbatim
  • Progress is tracked using percent correct or time spent to accomplish repetition
Low context sentences
  • using context to manipulate hierarcy of difficuly -- reduce contextual redundancy in order to encourage client to rely more on bottom up auditory or visual skills