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Pediatrics > 1 - Introduction > Flashcards

1 - Introduction Flashcards

1
Q

____ children are born with a hearing loss in Canada every year

A

2000

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2
Q

____ in 1,000 babies are born deaf or hard of hearing

A

4

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3
Q

What 5 ways do we communicate?

A

1) verbally
2) non-verbally
3) written
4) visually
5) listening

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4
Q

What is verbal communication?

A

Spoken words, use of speech and language

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5
Q

What is non-verbal communication?

A

Body language, facial expressions, eye contact, appearance, sign language, touch

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6
Q

What is written communication?

A

Written words to convey messages, drawing, text or computer

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7
Q

What is visual communication?

A

Visual messages like pictures, graphs, objects, sign language

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8
Q

What is listening communication?

A

Listening is one of the most important parts of communication as it helps you understand the perspective of the communicator and effectively engage with them.

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9
Q

What percentage of the Canadian population is culturally Deaf?

A

1%

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10
Q

____ of the deaf and hard of hearing children are from hearing and speaking families

A

96%

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11
Q

How fast does oral language development happen?

A

It happens automatically, quickly, easily, without formal teaching, using baby talk, they must have interactions

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12
Q

What is baby talk?

A

Baby talk is simpler vocabulary and sentence structures exaggerated intonation and sounds repetition and questions

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13
Q

If a child is never spoken too will they still acquire language?

A

No

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14
Q

What is the key to spoken language?

A

Hearing

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15
Q

Why is hearing the key to spoken language?

A
  • Hearing activates, stimulates and develops the auditory neural connections in the brain
  • Connections are needed for language to develop which leads to reading and academic success.
  • Hearing loss of ANY degree affects speech, language, academic, emotional and psychosocial development (secondary)
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16
Q

Why is early identification and intervention important?

A

With early identification and intervention the brain can have access to the sound and develop the way it should preventing the negative developmental outcomes caused by hearing loss.

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17
Q

Why is detecting hearing loss important?

A
  • Hearing occurs in the brain not in the ears
  • Hearing loss keeps sound from reaching the brain which prevents the growth of the auditory neural connections in the brain
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18
Q

Explain brain development

A
  • Sensory stimulation of the auditory centres of the brain is critical
  • Need a clear complete signal = well organized pathway
  • Filtered signal (hearing loss) = brain will be organized differently
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19
Q

____ affects the way the auditory brain pathways are organized.

A

Stimulation

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20
Q

What are the three main components of the auditory nervous system?

A

1) brainstem
2) auditory cortex
a) primary auditory cortex
b) secondary auditory cortex

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21
Q

What does the brainstem do?

A

Involved in auditory processing (sound localization, processing speech in noise, tuning and refinement of the auditory signal)

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22
Q

What does the auditory cortex do?

A

Where the acoustic signal becomes meaningful to the listener

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23
Q

Brain development is completely dependent on ____

A

Environmental experience

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24
Q

What is the role of the primary auditory cortex?

A
  • Assigned to detect and process auditory stimuli from the peripheral system (sound comes in, goes through pathway of ear, to primary auditory cortex)
  • All auditory input from the brainstem and thalamic region arrives here
  • Tonotopic organization in cochlea continues here (low frequency sounds lateral edge and high frequency sounds medial edge)
  • Timing of firing, numbers of neurons firing, tonotopic place the fire (remember this)
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25
Q

What is the role of the secondary auditory cortex?

A

Gives the listeners the ability to understand speech and derive meaning from sound
- Connects the auditory nervous system to the rest of the brain
- Relays Information back to the primary auditory cortex in the form of efferent tracts
- Neurons in the secondary auditory cortex can responds to multiple modes of stimulation
- Is a launching pad from which sound is distributed to the rest of the brain

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26
Q

What happens if there is an injury to Brodmann’s area?

A

Brodmann’s area 42 (damage to this is the inability to understand speech)

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27
Q

What are the connections in the secondary auditory cortex called?

A
  • intrahemispheric connections
  • has many neural connections to areas of the brain (frontal, parietal, occipital lobes, hippocampus, and amygdala)
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28
Q

What does the frontal lobe do?

A

movement, expressive language, executive function

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29
Q

What does the parietal lobe do?

A

processing somatosensory (touch, pain, temperature, sense of limb position)

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30
Q

What does the occipital lobe do?

A

visual processing area

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31
Q

What does the hippocampus do?

A

learning and memory

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32
Q

What does the amygdala do?

A

center for emotions, emotional behavior, motivation

33
Q

What do intrahemispheric tracts do?

A
  • Connects between the secondary auditory cortex and other areas of the brain
  • Exchange information between two areas in the same hemisphere
  • The tracts distribute auditory stimulation
    creating a network of sound neural tracts
    causing activation of primary, secondary
    corticies
  • Extract higher order meaning from a word
34
Q

What is an example of an intrahemispheric tract?

A

Corpus callosum allows information from right and left sides of the cerebrum to exchange

35
Q

What are efferent tracts in the second auditory cortex?

A
  • Efferent connections change the response of the primary auditory cortex allowing detection of important acoustic features so the person can recognize a sound
  • The brain combines the acoustic features, and the person can identify and understand the sound
36
Q

What is feature extraction?

A

Ability to selectively focus on acoustic characteristics of a sound which allows the sound to be recognized and identified.

37
Q

Relay is very important for ____

A

sound filtering (focus on certain characteristics to identify and recognize the specific sound)

38
Q

What is pluripotency?

A
  • Pluripotency neurons in SAC enable multimodal integration (auditory, visual, tactile, smell)
    • Hearing the word ocean (some people smell somthing, saw something, felt something)
  • Interaction between the secondary auditory cortex and brain is needed for sound to be meaningful.
39
Q

How is the secondary auditory cortex a launching pad?

A
  • Neural activity is delivered to other areas to form interconnection
  • Connectome:
    • map of neural connections in the brain (wiring diagram)
    • are formed by interaction/integration between the auditory system and other areas of the brain
    • developed during first few years of life
40
Q

What are the 2 ways connectomes are created?

A

1- Synaptogenesis
2- Arborization

41
Q

What is synaptogenesis?

A
  • Formation of synapses
  • Synapses - small gap at the end of a neuron thatallows a signal to pass from one neuron to the next the structures
  • Neuron to neuron contacts are formed causing neural pathways in the brain
42
Q

What is arborization?

A
  • Process in which new synapses are created
  • Experiences with consistent and meaningful input are needed to create and maintain synapses
43
Q

What is the critical period?

A
  • Time when brain cell connections are more plastic (capable of being molded or adapting to varying conditions
  • Receptive to growth/change in:
    • Synaptic count reach maximum between first and 4years old and decline after
44
Q

What is synaptic pruning?

A
  • Elimination of synapses in neural pathways that do not receive meaningful stimulation and are no longer needed
  • Synapsis are eliminated in order to increase the efficiency of neuronal transmissions.
  • Most useful connections survive to let brain focus on stimuli that most important
45
Q

What happens if synapses are not used/stimulated?

A
  • Synaptic pruning (elimination of synapses occurs)
  • We have to get rid of some neurons, but the ones that are continuously stimulated will build into these networks
46
Q

Role of Primary auditory cortex is for ____ and ____

A

detection, processing auditory stimuli

47
Q

Role of Secondary auditory cortex is for ____ and ____

A

understanding speech, deriving meaning from sound

48
Q

____, ____ and ____ happen during lifespan but are more prevalent during the first few years of life which is the critical period of development

A

Arborization, synaptogenesis, synaptic pruning

49
Q

____ is greatest in childhood

A

Brain plasticity

50
Q

Kral found critical period of auditory brain development was ____ months. What does this mean?

A

4-5
So auditory stimulation needs to occur by 4-5 months so the layers (V-VI) of the primary auditory cortex develop and coupling the secondary auditory cortex

51
Q

What do studies show about the critical period?

A

1) There is a critical period for the development of the neural connections/pathways
2) Children need access to auditory stimulation for the pathways to develop
3) The pathways can be developed with use of hearing technology

52
Q

____ is needed to distribute the acoustic signal throughout the brain and for sound to come to life

A

Secondary auditory cortex

53
Q

How does society measure success?

A

A great number of the mainstream measures of success are centered onmoney, power and status. No matter if a person measures success by material possessions, professional accomplishments, fame or even Facebook likes, they all boil down to money, power or status.

54
Q

What components affect success?

A

Achieving wealth (money)
Respect (power)
Fame (status)
Social skills
Higher expectations
Healthy relationships
Higher education level
Relationships with other kids
Less stress
Higher socioeconomic status
Read to their child

55
Q

Explain components of vocabulary

A
  • is tied to success in terms of school and work performance
  • is the highest predictor of income
  • and verbal reasoning skills are believed to contribute to reading comprehension
56
Q

What happens when you have difficulty reading?

A

Reading delays can interfere with academic development and understanding in the class

57
Q

What can mild to profound loss lead to?

A
  • Children with mild to profound loss can have delays in language development and academic achievement
  • We want to prevent speech, language, communication, literacy, social and emotional issues.
  • Early enrolment= better vocabulary and verbal reasoning skills
58
Q

What happens when children with hearing loss are exposed to greater amounts of speech?

A

Children who have hearing loss and are exposed to greater amounts of speech achieve higher spoken language outcomes than those who are deprived.

59
Q

Does ASL support spoken language development?

A

No

60
Q

Goal is ____ word exposure by the child’s 4th birthday

A

46 million

61
Q

Reduction in language outcomes in children implanted at ____ compared to ____

A

12 months, 6 months

62
Q

So the child is fit with technology/aid(s) and we are done?

A
  • No
  • Kids who wear HAs 10hrs a day achieved higher language score that children who wear aid less time.
63
Q

How does a count the dots audiogram work?

A

Step 1: Plot your audiogram on the count-the -dot template – each ear separately
Step 2: Count the amount of dots above the line
Step 3: Subtract this count from 100
Step 4: Your result indicates your speech intelligibility index

TheCount-the-Dots Audiogramprovides a way to estimate the ability to hear the acoustic energy of speech sounds. The moredotsthat occur below your hearing threshold line, the more speech energy you will perceive. This is a score out of 100. For instance – if there are 25 dots above the line, it roughly translates to around a 25% loss of speech intelligibility. and a 75% speech intelligibility score.

64
Q

Research shows children with sensorineural hearing loss can achieve language abilities similar to hearing peers with comprehensive and intervention strategies by ____ of age

A

6 months

65
Q

WE need to have ____ and ____ to improve language and academic outcomes

A

Early detection, intervention

66
Q

To achieve age appropriate spoken language we need:

A

1) Identify hearing loss within first month
2) Provide child with hearing technology ASAP
3) Need acoustically robust, language rich listening environment to provide 46 million words first few years of life

67
Q

What are the 6 ways to provide 46 million words to your child?

A
  1. Read aloud- most important activity, do it daily
  2. Talk- ask questions, encourage them to respond
  3. Nursery Rhyme- sing, action/finger rhymes, phonological awareness
  4. Music- expose to a variety, children’s songs, theatre, popular music
  5. Instruments- different instruments and play them
  6. Sounds- teach about different sounds animals and objects make
68
Q

What are the 8 roles of a pediatric audiologist?

A

1- Diagnosing hearing levels
2- Share information and determine families goal for the child (counselling)
3- Select technology and discuss communication options
4- Arrange for appropriate therapy or referrals to other team members
5- Follow up to monitor hearing thresholds & intervention/technology
6. Provide support, advocate for patient
7. Be knowledgeable about your field- teach others about audiology/hearing
8. Lifelong learning

69
Q

What are the 13 challenges for a pediatric audiologist?

A

1) Identifying children at a younger age
2) Identify more children with multiple conditions
3) Tests our ability to accurately diagnose hearing loss in very young children (ABR, OAE, behavioural)
4) Stretch available resources to include more children (unilateral, mild, fluctuating conductive)
5) Scheduling to accommodate the frequent appointments parents need
6) Educating physicians on the need for earlier, consistent
care to ensure proper follow up
7) How minimal is minimal? When do we amplify? parents and physician support
8) Tests our ability to provide appropriate amplification with limited information available
9) Challenges of keeping hearing aids on kids
10) Challenge of ear mold impressions and fittings
11) Staffing pediatric centres
12) Improved communication skills: professionalism in testing and interpreting results
Parents need to feel confident in your results and understand them if they are going to accept them
13) Maintaining quality screening procedures to identify all losses yet reduce the false positive rate.

70
Q

To be the best pediatric audiologist, what do you have to know?

A
  • To be the best pediatric audiologist you have to know what is typical or expected from children at different ages.
  • Speech, Motor, Hearing Milestones
71
Q

Developmental milestones: birth to 5 months

A
  • Startles to loud sounds.
  • Turns head/eyes towards a sound source.
  • Watches your face when you speak.
  • Vocalizes excitement and displeasure (laughs, giggles, cries, fusses).
  • Notices a toy that makes sound
  • Makes noise when talked to.
  • Begins to incorporate changes in pitch in cooing (intonation).
72
Q

Developmental milestones: 6-11 months

A
  • Turns and looks at direction of sound
  • Understands “no-no”.
  • Babbles (says “ba-ba-ba” or “ma-ma-ma”).
  • Tries to communicate by actions or gestures.
  • Begins to respond to requests
  • Attempts to imitate familiar sounds.
73
Q

Developmental milestones: 12-17 months

A
  • Begins to produce a variety of non-repetitive syllables such as “ba-ma” or “ba-go”.
  • Listens to stories, songs, rhyme
  • Pays attention to a book or toy for about two minutes.
  • Follows simple directions accompanied by gestures.
  • Answers simple questions nonverbally.
  • Points to body parts, objects, pictures, and family members.
  • Puts two words together to label a person or object (pronunciation may not be clear).
  • Say 1-2 word question (What’s that)
74
Q

Developmental milestones: 18-23 months

A
  • Enjoys being read to.
  • Follows simple commands without gestures.
  • Points to simple body parts such as “nose”.
  • Understands simple verbs such as “eat”, “sleep”.
  • Says eight to ten words (pronunciation may still be unclear).
  • Asks for common foods by name.
  • Makes animal sounds such as “moo”.
  • Starting to combine words such as “more milk”.
  • Begins to use pronouns such as “mine”.
  • Correctly pronounces most vowels and n, m, p, h, especially in the beginning of syllables and short words. Also begins to use other speech sounds.
75
Q

Developmental milestones: 2-3 years

A
  • Knows about 50 words at 24 months.
  • Knows some spatial concepts such as “in”, “on”.
  • Knows pronouns, such as “you”, “me”, “her”.
  • Knows descriptive words such as “big”, “happy”.
  • Says around 40 words at 24 months.
  • Answers simple questions.
  • Begins to use more pronouns such as “you, “I”.
  • Speaks in two to three word phrases.
  • Uses question inflection to ask for something (e.g., “My ball?”).
  • Begins to use plurals, such as “shoes” or “socks” and regular past tense verbs, such as “jumped”.
  • Speech is becoming more accurate, but may still leave off ending sounds. Strangers may not be able to understand much of what is said.
76
Q

Developmental milestones: 3-4 years

A
  • Groups objects, such as food, clothes, etc.
  • Identifies colors.
  • Uses most speech sounds, but may distort some of the more difficult sounds, such as l, r, a, sh, ch, y, v, z, th. (May not fully master these sounds until age seven or eight.)
  • Strangers are able to understand much of what is said.
  • Able to describe the use of objects, such as “fork” or “car”.
  • Has fun with language. Enjoys poems and recognizes language absurdities, such as “Is that an elephant on your head?”.
  • Expresses ideas and feelings rather than just talking about the world around him or her.
    Uses verbs that end in “ing”, such as “walking”, “talking”.
  • Answers simple questions such as “What do you do when you are hungry?”.
  • Repeats sentences.
  • Uses consonants in the beginning, middle, and end of words. Some of the more difficult consonants may be distorted, but attempts to say them.
77
Q

Developmental milestones: 4-5 years

A
  • Understands spatial concepts such as “behind”, “next to”.
  • Understands complex questions.
  • Speech is understandable, but makes mistakes, too.
  • Pronounces long, difficult, or complex words such as “hippopotamus”.
  • Says about 200 to 300 different words.
  • Uses some irregular past tense verbs, such as “ran”, “fell”.
  • Describes how to do things, such as painting a picture.
  • Defines words.
  • Lists items that belong in a category, such as animals and vehicles.
  • Answers “why” questions.
78
Q

Developmental milestones: 5 years

A
  • Understands more than 2,000 words.
  • Understands time sequence (what happened first, second, third)
  • Carries out a series of three directions.
  • Understands rhyming.
  • Engages in conversation.
  • Sentences can be eight or more words in length.
  • Describes objects.

Pediatrics (6 decks)

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