Rehab Audiology Exam 1 flashcards |

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What is Aural Rehabilitation

Facilitate language acquisition/habilitation
Reduce restrictions of communication
Provide benefit to client and communication partners
Goal is to minimize hearing related disabilities
Want to limit negative effects of hearing loss

Aural Habilitation

Parent advising/counciling/tutoring
Very young children with congenital hearing loss
Want to expose child to language

Aural Rehabilitation

Restoring lost state of function
Requires a team (Audiologist, SLP, Deaf Educator)
Primary person may depend on age of client

Audiologists Role in Aural Rehabilitation

Provides counciling services
Insurance doesn't cover this
Not really primary role see them annually/semiannually

SLP's role in Aural Rehab

Mainly work with pediatric cases of hearing loss
Facilitate development of language
Work with parent to help teach speech and language outside of visits

What does an Audiogram Represent

Audiograms are a visual representation of someones hearing level
Tells us the softest sound they can hear
Uses Speech Frequencies
250-8000 Hz

X (On an audiogram)

Left ear airconduction

O (On audiogram)

Right Ear Air Conduction

> (On Audiogram)

Left Ear Bone Conduction

< (On Audiogram)

Right Ear Bone Conduction

Triangle on Audiogram

Right Ear Air Masked

Square on Audiogram

Left Ear Air Masked

[ (ON audiogram)

Right Ear Bone Masked

] (On Audiogram)

Left Ear Bone Masked

A (On Audiogram)

Aided, patient is using their hearing aid
Sound Field instead of ear phone

CI (On an Audiogram)

Patient using their CI on a audiogram

Speech Frequencies

250 Hz- 8000 Hz

Speech Banana

Figurative area on an audiogram that shows us where speech sounds occur

Characterize Audiogram

Degree of Hearing Loss
Configuration of Hearing Loss
Symmetry of Hearing Loss
Type of Hearing Loss

Five Degrees of Hearing Loss

Normal
Mild
Moderate
Moderate
Severe
Profound

Normal Hearing

0 dB HL - 20 dB HL

Mild Hearing Loss

20 dB HL - 40 dB HL

Moderate Hearing Loss

40 dB HL - 70 dB HL

Severe Hearing Loss

70 dB HL - 90 dB HL

Profound Hearing Loss

90 dB HL +

Calculating Pure Tone Average

3 Frequency = 500 Hz 1000 Hz 2000 Hz
4 Frequency = 500 Hz 1000 Hz 2000 Hz 4000 Hz

Slope

Most Common
Can hear low frequencies better than high frequencies

Rising

Rare
Hear high frequencies better then low frequencies
Seen in conductive losses

Flat

All Frequencies at the same intensity
Children with SNHL tend to have this

Cookie Bite

Genetic
May become slope or flat over time

Tent Shape

RARE
Maybe caused by mixed hearing loss

Corner Audiogram

Good candidate for CI
Only hear very intense low frequencies

Three Types of Hearing Loss

Conductive
Sensorineural
Mixed

Conductive Loss

AC differ from BC on Audiogram
Treated with medical follow up
Site of Hearing Loss
Outer Ear
Ear Drum
Middle Ear

Sensorineural Loss

Not medically treatable
Site of Involvement
Cochlea
Auditory Nerve

Mixed Loss

Combination of SNHL and Conductive Loss
Outer, Middle, and Inner Ear involvement

Deafness in History

People with hearing loss were denied rights throughout history
NO outward sign of intelligence because they didn't speak

Geronimo Cardano

First physician who recognize deafs could reason
1500's
Had a deaf son and he created a code of symbols
Thought deaf people could be educated

Pedro Ponce de Leon

Invented signs to get out of the "Vow of Silence"
Priest
Taught the Deaf

Samuel Heinicke

First oral school in Germany
Tactile cues while speaking
1755

Charles Michel De L'Eppe

Start of formal Sign Language
1760
Priest
Established first free public school for deaf in France
Wanted to standardize sign/fingerspelling

Thomas Gallaudet and Laurent Clerc

Founded first American Deaf School in 1817
Connecticut Asylum for the Education and Institution of Deaf and Dumb Persons
Later to become the Connecticut School for the Deaf

Martha's Vineyard

Everyone signs
Had a large deaf population, probably from a genetic cause up to 1/4 of families were deaf
Deaf citizens were treated equal
Didn't formally educate Deaf on the isle

Golden Age of Deaf Education

1843-1912
Sign is flourishing, everyone is learning
Proposal for a Deaf State
30+ Schools for the Deaf founded

Gallaudet College

Opens in 1864
Lincoln signs the charter
Only accredited college to offer degrees to deaf students
Manual Method (Sign)

Alexander Graham Bell

Oralist
Opened school in Boston

Conference of Milan

Endorsement of oral education by international consortium of educators
Favored oralism
USA only country to oppose the oralist method

National Association of the Deaf (NAD)

USA's response to the conference of Milan
Kept sign language alive during the reign of oralism

Early 20th Century

Eclectic approaches: schools of lip reading
Electronic hearing aids debuted in the 20's
More rigorous effort at utilization of residual hearing aid in communication
WWII had a lot of adults who had a HL and that was different than a child born with a HL

Mid 20th Century

Audiology existed in the private sector
Audiologists can't dispense hearing aids
Focus on speech and lipreading

1960's

Recognition of need for early identification
Large body aids, limited power
Paucity of programs/ opportunities for the deaf and hard of hearing
Regionally defined in philosophical emphasis
Treatment averaged 1-2 hours a week
Minimal parent involvement

1970's

Legislation mandating provision of services to children with hearing loss in public setting: PL 94:142
Deaf read at a 3rd grade level
Some parent centered programs emerging
More emphasis on hearing
Emergence of Total Communication

Total Communication

Combination of speech and sign
sign systems emerged (PSE SEEI SEE II)

1990's

CI's debut
Digital amplification
This allowed hearing aids to become smaller

Speech Acoustic Importance in AR

We use this to understand speech
AR maximizes residual hearing
Gives more access to speech spectrum
How does amplification effect this

Importance of Aided Hearing

Better speech skills and phoneme recognition
Kids learn better because they have access to speech
Larger receptive vocabulary and that helps with reading levels later on

Waveform

Changes in amplitude over time
X Axis: Time
Y Axis: Amplitude
Vowels are dark area because they have the most acoustic energy
Can't distinguish between different sounds

Spectrum

Shows intensity (dB) over frequency (Hz)
Y axis is intensity
X axis is frequency
Good for vowel identification
No time dimention

Spectogram

Time on X axis
Frequency on Y Axis
Intensity is the darkness

Visual representation of components of speech

Formants

Acoustic resonances in the VT

Formant Transition

Movement of formant frequency
You see intensity change
Shows movement of the vocal tract
Occurs when vowels precedes or follows a consonant

Vowel Production

Open VT
Vowels differ by tongue height and frontness
Low and middle frequencies (<1000 Hz)
Easy for people with HL to identify
Most acoustic power in speech
Longer
Mark the syllables nucleus

Source-Filter Model

Source = VF Vibration
Filter = VT Shape
Output=Combination of source and filter
This allows us to precieve different vowels

Perceiving Vowels

Don't rely on absolute frequencies
Rely on the position of F1 and F2

First Formant

Responsive to changes in mouth opening (tongue height)
High =Low vowel
Low = High Vowel
This allows us to detect vowels

Second Formant

Responsive to the size of the OC or Tongue Frontness
High =Front Vowel
Low =Back Vowel
Allows us to differentiate vowels

Hearing Loss Effect on Formants

People with mid to high frequency loss struggle with differentiating F2

Distinguishing Vowels

Corner vowels are anchor
Use corner vowels to help distinct the other vowels

Acoustic Cues to Vowel Perception

Change in
Intensity Frequency and Duration
Just need to focus on F1 and F2

Diphthongs

Combination of two vowels
More dynamic
See a formant transition

Acoustic Characteristics of Consonants

Constricted VT
High frequency acoustic energy (above 2000 Hz)
Low intensity
Short
Marks end of syllables

Consonant Classification

Voicing
Manner of Articulation
Place of Articulation

Voicing

VF Vibration

Production of Semivowels

All voiced
Minimum constriction of the VT
Liquids and Glides

Acoustic Cues to Semivowels

Characterized by formant transitions
Glides distinguished by F2
Liquids distinguished by F3

Production of Nasal Consonants

All Voiced
VP Port opens to nasal cavity
OC creates the nasal murmur

Nasal Murmur

Low Frequency (500 Hz)
Easy for people with hearing loss to hear because of the low frequency

Manner Characteristics of Nasals

Weakening of formant intensity
Especially F1
Nasal murmur

Place Characteristics of Nasals

Transition in and out of vowels
Similar to homorganic stops

Production of Stops

Complete closure of VT
Cessation of airflow
Consonant release burst
Voice Bar

Voice Bar

Fundamental Frequency information
VF vibrate before stop burst
Voicing cue
Only voiced stops have this

Voicing Cue for Stops

Voice Bar
Aspiration
Timing Cues are Major factor
VOT length, longer yields voiceless

Manner Cues to Stops

Period of silence
Release burst
RAPID transitions in and out of adjacent sounds
Frequency, intensity, and timing are important

Place Cues for Stops

Frequency of most intense part of burst
F2 Transition
Frequency is Important
Hardest to Distinguish

Production of Fricative Consonants

Narrow constriction of articulatory tract
Creates turbulent air flow

Voicing Cues for Fricatives

Length of Sound (voiceless longer)
Intensity (Voiceless louder)
Timing and Intensity cues

Manner Characteristics of Fricatives

Extended period of noise then Stops
Timing

Place Characteristics of Fricatives

Frequency and Intensity
Sibilants a Non Sibilants
Sibilants are more intense

Production of Affricates

Combination of fricative and stop

Manner of Affricates

Relative Silence
Release Burst
Rapid Transitions
Frication
Duration cues MOST important

Patterns of Speech Perception and Hearing Loss

Minimal difficulties with voicing and manner because of the timing cues
Placement is the hardest
Misperception of final consonants because you lose intensity as the speech strand finishes

Hard of Hearing

Bilateral: PTA between 25-85 dB HL
Evidence based research supporting benefits of hearing amplification
Person with limited amount of hearing loss

Profound Deafness

PTA is equal to or greater than 90 dB HL
No speech perception
No benefits from hearing aids
CI candidate
Each person is different not homogenous
They have different auditory capacities and ability to benefit from amplification

Auditory Capacity

Capacity to detect and differentiate sound patterns
Varies in individuals with profound deafness
Partially predicts hearing aid benefits

Components of Auditory Capacity

Hearing Loss
Dynamic Range
Auditory Resolution

Hearing Loss

Varies across frequencies and influences auditory capacity
Degree/Configuration determines amount of gain a hearing aid provides
Degree/Configuration determines portions of speech spectrum that can be audible

Dynamic Range

dB difference between softest sound you can hear and loudest sound without pain
Want to increase this with amplification
Limited range makes it harder to fit a CI

Auditory Resolution

Inner ear reflects a spectral (frequency) and temporal (timing) differences amoung sound patterns
Limits individuals ability to perceive contrasts among amplified speech
Impacts speech perception even after HL and dynamic range issues are addressed
has effect on performance in noisy environments

Speech Cues

Vowels classified by vowel height and frontness
Consonants classified by manner and place of articulation and their voicing
Effects of hearing loss vary by degree of the loss

Intensities where Speech Cues Go Away

75 dB HL = Consonant Place
90 dB HL = Initial Consonant Voicing
100 dB HL = Vowel Place
105 dB HL = Vowel Place
105 dB HL = Talker Gender
115 dB HL = Syllable Number
>115 dB HL = Vowel Height

Auditory Capacity

Varies in individuals with profound deafness
Partially predicts hearing aid benefit
Difficult to assess clinically
Psychophysical measures difficult to apply clinically
Relationship between psychophysics and speech perception is not clear
PTA is inadequate

Auditory Performance

Competence distinction
Requires
Sensory aids to detect sound patterns
Listening experience to learn relationships between sounds and their source
Cannot reflect auditory capacity
Non native english speakers and young children

Audiogram Insufficiencies

Poor predictor of speech understanding
Especially for people with hearing aids or CI
Doesn't tell you how patient understands speech at the conversational level
Doesn't give you insight into how the patient performs in difficult listening situations

Factors in Test Selection

Age
Language Level
Cognitive Ability
Speech Intelligibility
Primary Language
Attention
Time
Length of deafness
Visual Acuity

Recorded Voice

Reliable everyone gets the same speaker and same words
Use this whenever possible

Live Voice

Flexible, can stop easily, especially with young children
Fast

Single Talker

Common in recorded measures
Easier for people with Hearing Loss

Multiple Talkers

Better ecological validity
You meet many people
Have to adjust to different voices

Closed Set

Selecting from a limited number of options
Doesn't require verbal response
Easy though
Think of a multiple choice question

Open Set

Options are theoretically unlimited
Harder
Not given possible answers
Think short answer questions

Unaided Presentation Level

Maximum comfort level
Want to see dynamic range

Aided Presentation Tests

Now test 50-60 dB SPL instead of 65-75 dB SPL
Do this because of ecological validity

Positive SNR

Most common SNR
Signal is louder then the noise

Negative SNR

Rare
Noise is louder then the signal

SNR = O

Signal and Noise presented at the same level

Auditory Visual Testing

Used for people with hearing aids because it makes speech perception easier
Not used for CI because they should be able to just have the auditory information

Word Frequency

How common the word appears in language

Neighborhood Density

How many other real words can you create by changing adding or deleting one phoneme in a word

High Density Words

Harder to recognize because they are easily confused

Low Density Words

Easy to recognize because the are not confused with other words

Low Frequency Words

Harder to recognize because they are not familiar

High Frequency Words

Easy to recognize because they are common

The clinician's knowledge that influences therapy choices and clinical decision making

Clinical reasoning is a way of explaining

Patient activities and participation are influenced by these

Restrictions and limitations of a health condition
personal Factors
Environmental Factors

Ethical Reasoning

What are the benefits and risks to the person related to service provision and do the benefits warrant the risk
Is an example of.

Prior

Diagnostic Reasoning may occer ___ to meeting client

CORE

C=Communication Status: Hearing Loss and Activity Limitations
O=Overall Participation Variables
R=Related personal Factors
E=Environmental Factors

CARE

C=Counseling and psychosocial (modifying personal attitude)
A=Audibility and amplification
R=Remediate communication activities
E=Environmental/coordination/participation improvement

Scientific Reasoning

Used to understand the nature of condition

Narrative Reasoning

Used to understand the meaning of the condition to the person
Therapists strives to understand each patients "story"

Pragmatic Reasoning

Used to understand the practical issues affecting clinical action
Concerned with clients ability to have support for disability outside of clinic

Child Slight to Mild Hearing Loss

21-40 dB

Adult Slight to Mild Hearing Loss

26-40 dB

Perilingual

Person who contract deafness while acquiring first language
Subset of prelingual

Prelingual

Person was born without hearing or lost hearing at an early
Speech/Language has yet to develop

Postlingually

Become deaf after age 5 had normal hearing and developed speech and language

Speech Descrimination

A person's ability to judge whether two speech stimuli are the same or different

Body Structure or Function

Under the ICF classification system, impairment refers to problems with

Three professionals who provide AR services

Audiologist
Speech-Language Pathologist
School Personnel

Residual Hearing

Auditory Training uses this to improve communication

Frequency range of human hearing

20 Hz - 20,000 Hz

Average level of conversational speech at 1 meter

65 dB SPL

Vowels

This speech sound has the greatest intensity

1000 Hz

Greatest amount of energy in speech is found below this frequency

Consonants

Carry the most importance of speech intelligibility

5 Distinctions of consonant production according to Miller and Nicely's

Voicing
Nasality
Affrication
Duration
Place of Articulation

4 Suprasegmental Features of Speech

Intonation
Rhythm
Stress
Pitch

Vowel Recognition

Is more accurate for vowels in context than for vowels in isolation

Rate of change in formant frequencies

Important acoustic cue for diphthongs

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