1/28 Aural Rehabilitation and its Purpose Flashcards
What are the goals of Aural Rehab (AR) - Receptive?
- Alleviate difficulties associated with losing one’s hearing.
- Minimize the consequences of the loss.
What is Conversational fluency?
How smoothly does the conversation flow?
What is Hearing-related disability?
Loss of function imposed by the hearing loss?
The Americans with Disabilities Act ( ADA) has a three-part definition of Disability. Under ADA, an individual with a disability is a person who has what 3 things?
(1) has a physical or mental impairment that substantially limits one or more major life activities; OR
(2) has a record of such an impairment; OR
(3) is regarded as having such an impairment.
What is a hearing impairment?
Structural or functional impairment of the auditory system.
What is a handicap?
Psychosocial disadvantages that result from a functional impairment. (The use of this term is discouraged.)
What are the three components of sound/hearing?
- Intensity/Loudness/Volume
- Frequency Identification/Distortion
- Duration/Processing
T/F: In most cases, when hearing loss gets to the point of needing Aural Rehabilitation the loss is most likely permanent.
True
What type of hearing loss is permanent?
Sensorineural
According to the World Health Org. (WHO) activity limitation is defined as what?
Loss of physical structure and function
According to the World Health Org. (WHO) participation restriction is defined as what?
Lifestyle change due to activity limitation
What are the Factors Related to Participation Restrictions?
- Limitations in communication activity
- Lifestyle
- Frequent communication partners: Or lack there of (widowed)
- Psychosocial issues
Who Discovered a link between Hearing Loss and Dementia?
Frank Lin,MD, PhD of John Hopkins School Of Medicine
What are the Limitations in Communication Activity?
- Use of appropriate listening device
- Management of physical environment
- Use of strategies to repair conversational breakdowns
How are people affected by hearing loss?
- Need to ask people to repeat themselves
- Get annoyed with themselves
- Use up extra energy to compensate
- Give incorrect answers
- Difficulty following conversations
- Extra concentration to hear someone talk/whisper
- Difficulty understanding TV
What are common signs of hearing difficulty?
- People seem to be mumbling
- Harder to follow a conversation in meetings, restaurants or noisy places
- Have difficulty hearing someone call you from another room.
- Have to turn up the volume on the TV or radio
- Family, friends or colleagues often have to repeat themselves
- Tend to limit social activities because it’s difficult to hear or communicate
What feelings do people with untreated hearing loss report?
- Sadness / Depression
- Worry / Anxiety/Anger
- Less Social Activity/Disinterested
- Irritability/Loneliness
- Fatigue/stress
What are some Psychosocial Issues?
- An individual’s attitudes, self-image, motivation, and assertiveness.
- Effect of positive and negative factors
- Affects participation and vice versa
- Societal viewpoints affect patient’s activity participation
What is habilitation?
- Developing a skill that was never present
- Primarily used in reference to children
What is rehabilitation?
Restoring a lost skill
What are the Components of an AR Program?
- Diagnosis - permanent hearing loss
- Amplification - Hearing aid (HA) and/or assistive listening device (ALD) fitting
- Auditory training
- Communication strategies training
- Counseling
- Speech-reading training
- Speech-language therapy
T/F: Teaching a pre-lingually deafened person to speak or read or write is ESL training?
True
What are the Areas AuD’s and SLP’s Conducting AR Need to Know?
- Audio-logic assessment procedures and treatment
- Audiogram: Severity, site of lesion, onset (age at which hearing loss was acquired), cause (pathology), and time course
- Speech-language assessment procedures
- Effects of hearing loss on communication: Speech banana, WR score, Formant
- Collaboration with other agencies
- Hearing conservation
What is the degree of hearing loss?
- Hard of hearing – Hearing Aids Help
- Deaf – Has hearing but hearing aids are minimally effective
- Deaf (capital D) – Deaf Culture – Sign Language Culture
What is the onset of hearing loss?
- Congenital
- Acquired
- Pre-lingual
- Peri-lingual
- Post-lingual: 4 divisions
What are the sites of lesion?
- Conductive
- Sensory
- Neural
- Sensorineural
- Mixed
- Central
What is the definition of conductive hearing loss?
- Obstruction within outer or middle ear
- Prevents sound from fully reaching inner ear
How can conductive hearing loss occur?
Congenitally
What is the treatment of conductive hearing loss ?
Medical treatment is possible in many cases
What are the causes of conductive hearing loss ?
- Craniofacial anomaly (examples: microtia, atresia)
- Cerumen
- Otitis media
T/F: These losses do not generally lead to the need for Aural Rehab?
True
T/F: Otitis Media can be a contributor to
Central Auditory Processing Disorder (CAPD)?
True
What does SNHL mean?
Sensorineural Hearing Loss
What is the definition of Sensorineural Hearing Loss (SNHL)?
Permanent hearing loss occurring in inner ear, auditory nerve, brainstem, midbrain or auditory cortex
What is the definition of Mixed Hearing Loss?
Evidence of both conductive & sensorineural hearing loss
What are the two different terms used to talk about time in hearing loss? *** I can’t think of the right verbage :-/
- Progressive hearing loss
- Sudden hearing loss
Are AR services used across the lifespan?
Yes
What are the AR services in infants?
- Advanced technology: HA/CI
- Higher survival rate of premature infants
- Early hearing loss detection and intervention (EHDI): ABR/OAE
What are the AR services in School-age children?
Educational planning and placement
What are the AR services in Adults?
Workplace and community contributions
What are the AR services in elder people?
- Maintenance of communication abilities: Active community participants, Stay in workplace, & Healthier routines
- Socializing – Brain Plasticity
- Bilingual Individuals with Hearing Loss
What are the AR communication models in children?
Overlapping home, school, and social environments
What are the AR communication models in adults?
Overlapping home, SOCIAL, and work environments
How is AR cost effective?
- Benefits of AR program vs. program costs
- Private insurance carriers
- Medicaid
- Medicare
So not really cost effective!
What is evidence-based practice (EBP)?
- Make clinical decisions for patient care: Clinical expertise, Patient values, Scientific evidence
- **Not “This is what we’ve always done”
- Use well-documented research of outcomes
In regards to EBP, what is outcome measures?
Amount of benefit experienced from treatment
In regards to EBP, what is Independent variable?
Factor measured in the experiment
In regards to EBP, what is Dependent variable?
Experimental Factor
What are the levels of evidence going from MOST credible to LEAST credible?
- Systematic meta-analysis of more than one randomized control trial
- Well-designed, randomized control trials
- Well-designed control trials without randomization
- Well-designed, quasi-experimental studies
- Well-designed, non-experimental studies
- Expert committee report, etc.
What is the Five-Step Approach to EBP?
- Ask question
- Use best evidence to answer question
- Determine if results pertinent to patient
- Determine if evidence applicable and feasible to patient
- Measure performance following intervention
What does an audiological assessment consist of?
- Audiometer: Instrument to measure hearing sensitivity
- Threshold: Softest sound detected 50% of time
- Insert earphones/headphones/soundfield
- Bone oscillator/vibrator
What is Speech Recognition/Word Understanding also referred to as?
speech perception
What is Speech Recognition/Word Understanding/speech perception?
Ability to Recognize speech phonemes, words, and sentences
What is Speech Recognition/Word Understanding?
- Optimized through amplification and cochlear implants (CIs)
- Assessment for 3+ y/o
What does an audiogram consist of?
- Pure Tone
- Speech
Audiological terms: What does SRT mean?
Speech Reception threshold
Audiological terms: What does SDS mean?
Speech Discrimination Score
Audiological terms: What does WR mean?
Word recognition
What are the 3 non- audiological terms?
- Speech Recognition
- Word Understanding
- Speech Perception
How do you measure the degree of hearing loss?
- Audiogram: Frequency (Hz) & Decibel (dB)
- Pure tone average
- Configuration
When talking about pure tones, what is normal for children?
-10 dB to +15 dB
When talking about pure tones, what is normal?
0 - 20 dB
When talking about pure tones, what is Mild?
25 - 40 dB
When talking about pure tones, what is Moderate?
45 - 65 dB
When talking about pure tones, what is Severe?
70 - 85 dB
When talking about pure tones, what is Profound?
90 - 110 + dB
What are the 3 aspects of understanding?
- The loudness of things
- The tuning of things
- The processing of things
In a young brain these processes may not be fully developed, what are they?
- What’s the sound?
- Is it speech?
- What are they saying?
- Who’s talking?
- Are they talking to me?
- Where are they located?
T/F: But In older brains these processes may be breaking down.
True
What is the Degree of Hearing Loss?
- Bilateral vs. unilateral
- Symmetrical vs. asymmetrical
- Fluctuating vs. stable
How do you Identify the Type of Hearing Loss?
- Air conduction: which reveals the overall perceptive loss
- Bone conduction and its difference from air conduction: which reveals differentiation of conductive versus sensorineural loss
- Air-bone gap: Difference between air and bone thresholds & Reveals conductive loss
5 Rules to Differentiate Between Conductive and Sensorineural Loss ***** (NEED TO KNOW THIS)
- If air conduction threshold (ACT) is within normal limits and bone conduction threshold (BCT) for that same frequency is in normal limits and they do not differ from one another by 10 dB or more then this individual has normal hearing.
- If ACT is in normal range and BCT is in normal range but differ from one another by 10 dB or more then there is Conductive Dysfunction and referral is required.
- If ACT is outside normal limits and BCT is within normal limits and BCT is 10 dB or better than the ACT then the loss is conductive in nature.
- If the ACT is outside normal limits and the BCT is outside normal limits and they do not differ from one another by 10 dB or more then the loss is sensorineural in nature.
- If the ACT is outside normal limits and the BCT is outside normal limits but the BCT is better than the ACT by 10 dB or more then the loss is mixed in nature.
**LOOK AT THE PICTURES OF AUDIOGRAMS
.
If you have a mild degree of loss on word understanding in a quiet environment, what is the effect of speech recognition?
Little to no effect
If you have a moderate degree of loss on word understanding in a quiet environment, what is the effect of speech recognition?
Little effect if topic known, face-to-face, and familiar vocabulary
If you have a moderate degree of loss on word understanding, what is the effect of speech recognition without hearing aids?
Miss half to all speech
If you have a moderate-to-severe degree of loss on word understanding, what is the effect of speech recognition without hearing aids?
Major effect; miss most to all speech, even face-to-face, particularly in groups
If you have a severe degree of loss on word understanding, what is the effect of speech recognition without hearing aids?
Major effect; no recognition; only hear loud speech
If you have a severe degree of loss on word understanding, what is the effect of speech recognition with hearing aids?
Detect environmental sounds
If you have a profound degree of loss on word understanding, what is the effect of speech recognition with hearing aids?
may detect loud sounds
If you have a profound degree of loss on word understanding, what is the effect of speech recognition without hearing aids?
Full effect; visual cues important; sound is vibrotactile
If the configuration is low frequency loss; frequency is hearing loss below 1000 Hz; what is the effect on speech recognition?
Can hear more speech sounds from mid to high range
If the configuration is high frequency loss; frequency is Hearing loss in mid-high to high frequency range; what is the effect on speech recognition?
Affects high frequency consonants, such as s, sh, t, p, k, and f; may be difficult to discriminate between d, b, g, v, z, h, l, r, and w
What does the Speech reception threshold (SRT) consist of?
- Use spondee words to obtain
- Bisyllabic words with equal stress
- Softest level can repeat 50% words
What does word recognition scores (WR) consist of?
- Percentage correctly repeated presented at comfortable level
- Uses a phonetically balanced word list - 100 words on each list; Monosyllabic Words; The list represents all of the important phonetic sounds in English.; Words are represented in proportion to their occurrence in everyday speech.
What does Speech Audiometry - Unaided consist of?
- Most comfortable loudness level (MCL): Level for listening to speech comfortably
- Uncomfortable loudness level (UCL): Level speech becomes uncomfortably loud
- Dynamic range = UCL – SRT or PT Thresholds - TDs: Influences listening device selection & Influences development of auditory training program
What are the Considerations for Speech Recognition Assessment?
- Purpose
- Patient variables
- Stimuli units
- Test procedures
What is the Purpose of Speech Recognition Assessment?
- Determine if amplification is Possible
- Compare aided vs. unaided performance
- Hearing Aid Evaluation
- Reveal speech recognition difficulties to patient
- Demonstrate benefits of visual cues for speech
- Obtain performance when listening in background noise
- Track performance over time
- Determine need for speech perception training
- Determine level to begin speech perception training
- Determine most appropriate educational placement
- Verification of benefit of amplification
What are the Patient Variables of Speech Recognition Assessment?
- Age and/or cognitive skills: Test must reflect abilities: Attention span; Compliance to take test
- Linguistic competency
- Vocabulary and syntactic knowledge
- Degree of loss
- Mode of communication
What are the Stimuli Units of Speech Recognition Assessment?
- Test selection
- Stimuli: Suprasegmentals, phonemes, words, phrases, or sentences
- Stimuli: Nonsense syllables, monosyllabic, or spondees
- Population: Children or adults
- Format: Open or closed set & Number of choices in set
What is the speech feature analysis?
- Analysis of errors during speech testing
- Subjective analysis of errors and confusions
- Formal statistical analysis
- Information transmission analysis
- Multidimensional scaling
- Cluster analysis
What is the consonant classification?
- Nasality
- Voicing
- Duration
- Frication
- Place
- Envelope
What are the advantages of phoneme stimuli?
- Unaffected by vocabulary level
- Can perform feature analysis
What are the disadvantages of phoneme stimuli?
- Usually not appropriate for children
- Poor face validity
What is Monosyllabic Word Stimuli?
- Most commonly used stimuli
- Phonetically balanced word lists (Phonetically-Balanced Kindergarten (PB-K))
- Acoustic lexical neighborhood word lists (Lexical Neighborhood Test (LNT), Multi-syllabic Lexical Neighborhood Test (MLNT))
- Frequency of occurrence determines neighborhood: Dense neighborhood (many similar words); Sparse neighborhood (Few similar words)
What are the advantages of word stimuli?
- Higher face validity than nonsense syllables
- Easy to score
- Able to do fine-grain scoring
What are the disadvantages of word stimuli?
- Not representative of everyday listening situations
- Limited vocabulary influence outcomes
(Stimuli Units of Speech Recognition Assessment) How may phrases and sentence help?
- May or may not be topic-related
- Higher face validity: Relate to real-world stimuli
- Prosodic cues: Intonation, rate, and duration
- Contextual information: Redundancy leads to recognition
- Coarticulation: Word transition provides redundancy for recognition & Allows for prediction
What are the advantages of phrases and sentences?
- High face validity
- Reflects real-world performance
What are the disadvantages of phrases and sentences?
- Linguistic knowledge influential
- Familiarity of topic influential
What are the 3 test conditions of a speech recognition assessment?
Audition only: no visual cues
Vision only: Speechreading
Audition + vision: Both simultaneously
What does audition only consist of?
- Sensation level (SL): dB above SRT
- Use of background noise
- Speaker-talker babble
- Speech noise
- White noise
- Signal-to-noise ratio (SNR)
- Speech stimuli 10 dB louder than noise = +10 SNR
- Speech stimuli 10 dB softer than noise = -10 SNR
What does vision only entail?
- Talker’s head and shoulders are visual
- Talker faces patient 0 degrees azimuth
- Assesses lipreading/speechreading ability
- Computer testing allows test pacing and on-line scoring
What does audition+vision encompass?
Demonstrates best performance scenario
Hearing so poor, audition-only not feasible
Patient may be good speechreader
Speechreading enhancement scores: AV% correct minus V% correct; AV% correct minus V% divided by 100% minus V% correct
What are some considerations of the Test Procedures of Speech Recognition Assessment?
Response format: Closed vs. open set
Test presentation: Recorded vs. live-voice stimuli
Test talker styles: Voice frequency; Intonation; Speech rate; Articulation & Physical characteristics
What are some recorded test materials?
Synthesized speech is computer-generated
Altered speech is modified by:
- Time-compressed – accelerated speech;
- Expanded – decelerated speech;
- Low-pass filtered – lets low Hz’s in but attenuates high Hz’s;
- High-pass filtered – lets high Hz’s in but attenuates low Hz’s
What are test considertations?
Learning effects
- Performance affected by familiarity of test items
Compensate by:
- Using equivalent lists
- Though not reliable - Increasing number of test items per test
- Using closed-set matrix format
Test-retest variability
- Individual performance or motivation
- Nature of test
Test reliability
- Repeatable test results
Test validity
- Test measures what it says it measures
Mode of presentation
- Live-voice to recorded stimuli
Location
- Sound booth to clinic office
Talker
- Familiar vs. unfamiliar
- Male vs. female
Repetition of test items affects performance
Clinical significance
Monolingual or bilingual patient
- Appropriate materials for bilingual patient
- Tester should understand language to score accurately
