Aural Rehab/Audiology Final flashcards |

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Goals of Auditory Training

- Recognize and interpret speech
- Use residual hearing to maximum capability
-Will not change hearing but will enhance ability to utilize sound

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What were the first two schools to promote auditory training in the US?

Currier in NY
Gillespie in Nebraska

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Who is Raymond Carhart?

The "father of audiology," developed programs to help soldiers with hearing loss from WWII

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Candidacy for Children (for Auditory Training)

-Prelingually defeaned
-Post lingually deafened

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Candidacy for Adults (for Auditory Training)

Change in status in hearing due to
-C.I
-Trauma
-Ototoxic drugs

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Difference in Auditory Treatment for post-lingually and pre-lingually deafened children

Prelingually deaf:
-Must learn to 'attend to' sound
-Have no memory of sound or knowledge how it works
Postlingually deaf
-Can start with more difficult taks
-Normally initially able to better deduce meaning from sound

What are the 4 design principles of auditory training A.S.A.D?

Auditory Skill
Stimuli
Activity
Difficulty

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Auditory Skill (4 levels)

"Awareness plus the three 'ions'"
Awareness
Discrimination
Identification
Comprehension

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Sound Awareness

Most basic auditory skill level- awareness of when a sound is present and when it is not

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Sound discrimination

Ability to tell if two sounds or different or the same

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Patter perception

Ability to distinguish between words or phrases that differ in number of syllables

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Identification

Listener able to label auditory stimuli

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Comprehension

Listener able to understand meaning of spoken message

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Analytic Tranining

Type of stimulus unit- training emphasized recognition of individual speech sounds or syllables

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Synthetic Training

Type of stimulus unit- training emphasizes meaning and context but not each word

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Formal training vs informal training

Formal takes place in a set, structured setting
Informal intergrates training into everyday life

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Vowel Auditory Training Objective

-designed to contrast vowels with different formants
1) vowel awarness 2)distinguish between sounds 3)identitify

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Vowels- formants

Resonances in the vocal tract cause some frequences to have more energy than others
1st and 2 formants distinguish vowels from one another

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Consonant auditory training objectives PVM

Auditory training designed to contrast the features of articulation 1)Place 2)Voicing 3)Manner

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Place (5 places) The man with the van with his thumb in a glove drove the ship

Bilabial- lip to lip "man"
Labiodental- teeth to lip "van"
Linguadental- tongue to lip "thumb"
Palatal- tongue to palat (roof of mouth) "ship"
Velar- tongue to back of mouth "glove"

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Manner (5) F.S.A.G

Fricative- air through constricted mouth 'hsssss'
Stops
Nasal
Affricates- fricative + stop "ch"
Glides

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Easiest consonant features for deaf people to distinguish

Nasal and voice

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Suprasegmental

Variations in pitch, rate, intensity, prosody (rythm) and duration imposed on segmentals (words and phonemes)

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3 stages of auditory training?

1. placement
2. goals
3. objectives

Auditory Cortex

Part of brain that processes auditory info

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Skills that correlate with sucess of speech reading

Visual word decoding
working memory
lexical identification speed
phonological processing
verbal inference making
assertiveness

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Visemes

Speech sounds that appear idential on the lips

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Homophenes

Words that look identical on the lips 47-56% of words in Enlish are homophenes

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Talker effect

Same sound may look different when spoken by a different person

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Most difficult consonant feature for a deaf person to identify

Place

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McGurk Effect

What we hear influences what we see and vice versa (visual intergration)

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Audiovisual intergration

Occurs when information form the auditory and visual signal combine to form a unified perception

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Coarticulation

Same phoneme may look different when spoken in combination with another, influenced by vowel following consontant

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Stress effects

...

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Neighbor Activation Model (N.A.M)

...

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Intersection density

...

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Variable affecting performance

...

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SNR (signal to noise ratio)

DB of sound interest
- DB of background noise
________________________
SNR

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What is the optimal SNR for comprehensionfor people of normal hearing?

+6 DB

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Canonical babbling

Advanced form of babbling, 10 months

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Normal steps taking before a CI surgery

1. Evaluation
2. Assesment of hearing
3. Assesment of Otologic and general health
4. Assesment Physchological status

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CI Couneling covers

Post op management
Realistic espectations

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History of CI

1790- Volta put eletrode in ear
1950- Djourno developed electrical auditory prothesis
1960-1970- Dr. William House and Dr. Graham Clare research wearable device
1957- Eyries put this in an ear
1980- C.I widely used
1990- FDA approves C.I for children

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Interleaved pulsatile stimulation

C.I (sound) processing stragety- trains of pulses are delivered across electrodes in non simulatenous fashion
(pew pew pew pew pew)

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Electrode pairs

Tiny exposed balls or rings on electrode array wire comprised of positive and negative polarity contacts
+ + ++ + +
{ { { { { {
- - - - - -

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3 Major CI companies

Cochlear Corp- 1st mult channel device
Med-EL
Advanced Bionic

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Battery life of a CI

3-5 days or 9-17 hours (rechargable)

External Components of CI

Speech Processor
Transmitter
Cable

Internal Components of CI

Reciever
Electrode array (composed of electrode pairs)
Reciever

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Tonotopical organized

The cochlea is oranized tonotopical with low frequecies at apex (center) and high frequencies on basal end (part near round window)

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Mapping CI

Determine threshold (T level)
Maximum comfort level- C level
Loudness Balancing
Pitchranking

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T level

Electronic threshold of CI- just aware of sound

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C level

Maximum comfort level
Maximum level sound can be listened at comfortably for a long period of time

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Loundess balancing

Programming the speech processor so stimulation follows contour of imcoming speech level (if not balanced popping sounds are heard, or no speech info)

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Pitchranking

Determind ability to discriminate pitches from stumulation of basal to apical electrodes (two electrodes are stimulated, one after the other, patient says which is higher)

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Auditory Continuous Permformance test ACPT

Asses child attention/vigilance

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Vilignace-

Intergrates 3 dimensions of attention
-Alertness- readiness to recieve stimulus
-Selection- perceiving stimuli as being different and requiring a specific response
-Effort- effect invest in test

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ACPT

Child (6-11) listens to words and raises thumb every time hears 'dog'
15 minutes
20 monosyllabic words are repeated and arragned to form 96 word list

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Dichotic Digists

Evalautes binaural intergration skills
-relies on ability of two brain hemispheres to communicate with each other
-Student's ability to process mult stimuli

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Time Compressed Speech

Tests temporal processing
Assesses how CANS processes degrade acoustic stimuli over time
"Say the word ___"

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Which phonmes are more visible than others (consonants)

Consonants with lip closure
Consonants with tongue towards front of mouth

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Are vowels visible?

No, not associated with distinct mouth movements but are more acoustically salient to people with HL

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How fast does the average person speak?

150 to 250 words per minute

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Variables that effect speaking rate

-Emotion
-Social Etiquette
-Fatigue
-Articulation style

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What does a CI do

-Bypasses hair cells in choclea (damaged by SNHL),
-Stimulates auditory nerve directly
-Neural impulses are sent to the brain as if the chochlea had been stimulated via acoustic input

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CI Candidacy for Adults

Bilateral, SNHL
50% less sentence rec in ear to be implated
60% or less in better ear

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Cochlear Ossification

Common with mengitius
Electrode may be partially inserted

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Possible complcations

Loss of residual hearing
Infection
Fluid accumulation under incision site
Irration over site
Facila Nerve Paralysis
Post-op middle ear infection
Pain in implant site
Facial nerve stimulation during programing
Risk of anesthesia and surgery
Leakage in cochlear fuilds
Risk of menigitis

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Goals with hearing conservation in aural rehabilition plan

Educate individuals on how to preserve and protect residual hearing

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Prevalence

+30 million Americans are exposed to hazardous sound levels on daily basis
-Excessive noise is most commone cause of hearing loss
-10 million Americans have experianced loss b/c of this

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2 classifications of noise

Transient or impulse
Continuous noises- constant for at least .2 seconds (more damaging)

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2 types of noise induced loss

Acoustic trauma- permanent
Temporary Threshold Shift- TSS (may case permanent threshold shift after time- PTS)

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What does NIHL look like

Damage occures in 3-6kHX region of cochlea

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Symptoms and effects

TTS- muffled hearing, fullness or pressure in ear, tinnitus
NIHL- loss in HF sounds
Decreased speech discrimintation
Tinnitus

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Health effects of NIHL

Fatigue, anexiety, social withdrawl, depression, hypertension, stress, sleep disturbances

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5db rule

For each 5b increase in intensity permissible noise exposure is halved

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TWA

Time-weighted average- equates a sound level of 8 hours

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