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School Age Language > Aural Rehab > Flashcards

Aural Rehab Flashcards

1
Q

Aural Rehab with elderly and babies

A
  • Done with elderly individuals due to sensorineural hearing loss- you can’t amplify for sensorineural hearing loss but this population has language
  • With this population we need to teach them strategies, reduce noise (manage the environment), speech reading cues (facial expression, gestures, and looking at the lips)
  • Noise induced hearing loss- conductive
  • We do it with babies (universal hearing population)
  • Cochlear implants, hearing aid
  • Detection is the first step (responding to sound)
  • Discrimination is the second (hear things as different sounds)
  • Identification or recognition (know what the sound is)
  • Comprehension
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2
Q

Richard and Robert Kretschmer were hearing children of deaf parents

A
  • “It is unfortunately true that despite 150 years or more of concern, quality research that specifies in detail the nature of linguistic problems associated with childhood deafness is still lacking.” (Kretschmer & Kretschmer, 1978, p. 85)
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3
Q

What is normal among deaf children

A
  • Maxwell (1994): “Because of our ignorance of what we should expect in communicative development, we have no clear picture of what is normal among deaf children” (p. 231)
  • We can compare them to hearing children, but we don’t know how profoundly deaf children perform
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4
Q

Delayed

A
  • Are deaf or hearing impaired kids delayed?
  • Implies “catch up” with time
  • Do kids who are hearing impaired or deaf catch up over time?
  • Yes and no
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5
Q

Deviant

A
  • Acquisition is different

— hearing loss affects cognitive development

— and ASL affects cognitive development and expression

  • SO, language must be different
  • This is the way Myklebust, told us to view hearing loss back in the 60’s
  • Part of the strong cognition hypothesis
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6
Q

Language and culture of the deaf community

A
  • English is the second language

— (ASL or gesture is first)

  • cultural issues as well as issues over identity

— which group belong to?

  • Clash with culture if you are a deaf student with an interpreter in the hearing world
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7
Q

Difference

A
  • Children learn language naturally

— for hearing impaired, only auditory processing is different

— With proper input no language or cognition deviance will happen

— Delay (and only delay) may be present

— Must provide opportunities for learning

  • Auditory verbal training or auditory verbal techniques

— Hearing loss is a neural developmental emergency

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8
Q

Delay then ?

A
  • According to Kretschmer & Kretschmer

— Learn language like their typical hearing peers in early years (developmental progression is same)

BUT

— But in school years, same kids now look different

——- May not mirror developmental progression

——– DEVIANCE! Or is it?

  • Contradictory slides because the information is contradictory
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9
Q

School-age Children

A
  • Truncated language performance (not as proficient or complete)
  • More use of nouns that relate to self action
    which seems related to educational programs (and therapy)

— Drill and focus on grammar mastery, rather than effective communication and meaning

——– Decline in social pragmatics

——— Oh, so our intervention focus results in differences between HI/Deaf and hearing peers

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10
Q

Impact of minimal hearing loss

A
  • High frequency loss (1, 4, 6K Hz)
  • 20 years of research by Vanderbilt Univ.

— 10 times more likely than peers to have academic difficulty

— 1/3 likely to have repeated a grade or had resource assistance

  • Preferential seating is not sufficient

——- Maximize the sound signal ratio

——- Front of the classroom is not
necessarily the best spot if the teacher moves around

——- You want them to be in the arc of arms

——- FM listening systems can help

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11
Q

Children with CI and oral education

A
  • Children who have CI and are oral have educational advantage over children who sign at school age

— More likely to be mainstreamed

— Better scores on auditory perception**

— Better scores on speech intelligibility**

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12
Q

Delays in children with CI

A
  • Delays in children with cochlear implants are due to existing delays at time of implantation
  • Earlier implantation resulted in hearing peer equivalent scores on PLS by 4.5 years (expressive language)

— Not obtained if implanted after 2 years

  • Could be harmful to language if parents use the wait and see approach.
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13
Q

Sign and oral children

A
  • Both sign and oral children are significantly below hearing peers in educational testing
  • Deaf children of deaf parents are equivalent, whether primary communication mode is oral or sign

— Find out the family preference

— But if we don’t work on speech, literacy is adversely impacted

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14
Q

Phonemic awareness (Miller 1997)

A
  • Used Hebrew
  • Oral group did significantly poorer job making phonological judgments than the signing or hearing group (no difference between these last two groups)
  • Oral group had longer response latency
  • No difference in phonemic awareness between oral and signing groups
  • Key to reading success
  • Phonemic awareness- distinguish differences at the phoneme level
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15
Q

Cochlear implant or hearing aid

A
  • Blamey et.al., (2001) study of 87 children
    followed for 3 years
  • CI (>100 dB loss unaided) and hearing aid (unaided PTA loss of 78 dB)
    PTA= pure tone average
  • Oral program, integrated part of day
  • Little difference between the groups
  • CI- kids were more impaired

— Electrodes are inserted into the cochlea and do the detection and send it to the brain

— Need to learn to recognize the new signal

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16
Q

Development of vocabulary and language

A
  • Development of vocabulary and language progressive, but at 60% of rate of hearing peers (whether it was a hearing aid or CI)
  • Predict average language delay of 4 years at middle school (age 12) without intensive language training
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17
Q

Time of implant

A
  • Time of implant significant (cont’d)

— TC kids better spoken vocabulary if implant prior to early elementary school

— Both OC and TC kids better if implant as preschooler rather than elementary school years

(Blamey et. al., 2001)

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18
Q

Phonological awareness and CI (James et. al, 2005) 1

A
  • Compared phonological awareness ability in children with cochlear implant and 2 groups deaf children with hearing aids (profoundly HI and severely HI)
  • Research suggests that speech perception abilities of children with CI is equivalent to severely deaf (Blamey et.al, 2001 in James et. al,2005)
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19
Q

Phonological awareness and CI (James et. al, 2005) 2

A
  • PA is related to literacy & language, more than to auditory perception
  • Results suggest that CI offers some help in development of PA

— However, for 2/3 tasks (rhyme, phoneme awareness) scored most like profoundly deaf

— Scored like severely deaf on syllable tasks

— CI did not help

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20
Q

Acquisition of Language

A
  • Robert Kretschmer, Jr. reported studies which show that hearing mothers of deaf children are less effective in “teaching” language than hearing mothers of hearing children
  • Examined parent-child interaction of mothers of deaf children with slow vs. rapid language development
  • Rapid (high language scores)

— Kids looked at moms more often, moved away from moms more often

— Moms looked more often at kids, had more eye contact, less touching and more distance

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21
Q

What we do know about children who are deaf

A
  • Children who are deaf acquire a first language (multimodal) through one/some/or all communication modes, but have difficulty transferring between systems

— ORAL

— GESTURE

— SIGN/FINGERSPELLING

— WRITTEN

22
Q

Oral Deaf Children of hearing parents

A
  • Oral deaf children of hearing parents score better than total communication deaf or hearing parents
  • Geers, Spehar & Sedey (2002) review studies that indicate non-CI kids have greater language skills in sign over speech when in TC program
  • Total communication is not always total communication because teacher doesn’t always talk and sign and vice versa at the same time
23
Q

Delayed Babbling

A
  • Onset about 12 months (compared to 6 months when typical hearing)
  • Canonical babbling (consonants & vowels with adult-like timing; reduplicated and variegated babbling) as late as 31 months (compared to 6-9 months when typical hearing)
  • Babbling in sign language exists, no ages provided to determine if delayed or not
24
Q

Different Babbling

A
  • Less instances of canonical babbling
  • Restricted phonetic inventory
  • More low frequency phonemes

— Nasals, glides [Typical hearing stops before glides]

— You can get more tactile feedback from sounds

— Provide more visual cues

  • Ease of production
  • Vowels, bilabials [typical adds alveolars]
  • Provide more visual cues
25
Q

Disordered Babbling

A
  • Fail to attain full phonetic inventory without intervention (or attain very late, 4-5 years or later)
  • Plateau early
  • May fail to improve intelligibility and phonetic inventory after age 8 years, regardless of treatment
26
Q

Gesture

A
  • Young children who are deaf develop organized & symbolic gesture systems; the organization is different than English
  • Gestural language develops even in totally oral focus
  • All deaf children use some form of gestures
27
Q

Sign Language 1

A
  • Articulation errors, or “baby signing”

— Hand configuration

— Hand movement

— Hand placement relative to body

— Two hands together

  • Sign develops faster than speech

— 20 signs at 10 months of age

— Two-sign combinations at 16 mo. of age

  • In other populations articulation errors do not go away
28
Q

Sign Language 2

A
  • Syntax is not consistent with spoken language
  • “Phonological processes”

— Facial gestures

— Hand gestures

— “normal” facial expression

  • ASL is deictic (sign towards them) - subject is often not spoken
29
Q

Speech and Voice

  1. Phoneme Production errors
  2. Vocal Quality
A
  1. Omissions

Distortions

Substitutions

  1. Breathy

Harsh

Glottal fry to falsetto

Variable loudness

Hyper/hyponasal

Throaty (little oral cavity resonance)

Cul de sac (little oral cavity resonance

30
Q

Speech (from Pratt, 2005) 1

A
  • Hearing loss and speech ability positively related (mild loss, mild speech disorder)
  • Mild loss disorders include:

— hoarseness, resonance & voicing errors

— Affricate & fricative substitutions higher than hearing peers

— Errors on /r/

— Final consonant deletion (less acoustic energy, glottal stop, or less release of a final consonant)

— Deletion of back consonants

31
Q

Speech (from Pratt, 2005) 2

A
  • Historically, profound loss meant little intelligible speech
  • Early intervention has increased possibility of intelligible speech with profound loss
  • You have to think about how you speak to these clients
  • Speak conversationally
32
Q

Speech and Voice

  1. Prosody and Pitch
  2. Rhythm and Timing
A
  1. Flat, monotone
  2. Improper stress
    - Improper pausing
    - Over articulation (lack of co-articulatory changes)
33
Q

Suprasegmental ability and hearing impaired

A
  • timing
  • rhythm
  • intonation contours
  • Pflaster (1976, dissertation at Columbia) found that orally integrated children were more successful if suprasegmentals were good, up to age 10; at age 10, receptive skills more indicative of success
34
Q

School and HI

A

Kretschmer on classroom studies:

  • teachers dominate conversations
  • few student initiations
  • memory work is emphasized
  • very little work on developing inferences
  • very few classroom discourse skills evident (request/provide clarification; obtain information; suggest)
35
Q

Deaf and Hearing Impaired: Speech and Language Assessment 1

A
  1. Preferred communication modality (oral, sign, total)
  2. Articulation skills of speech and/or sign
  3. Knowledge & use of morphemes in English and/or ASL
  4. Knowledge & use of syntax in English and/or ASL
36
Q

Deaf and Hearing Impaired: Speech and Language Assessment 2

A
  1. Semantics of preferred communication mode
  2. Pragmatics
  3. metalinguistic skills
    - judging grammaticality of utterances
    - paraphrasing skills
    - metaphors and other figurative language
  4. Suprasegmental ability
    - timing
    - rhythm
    - intonation contours
37
Q

Rhode Island Test of Language Structure

A
  • Receptive Language:

—- Rhode Island Test of Language Structure by E. Enger & T. Enger (1983). Baltimore University Park Press.

———- syntax in both signed and spoken language

———- Normed for ages 3-20 with hearing impairment; 3-6 for typical hearing individuals

38
Q

Grammatical Analysis of Elicited Language

A
  • Expressive language

—- Grammatical Analysis of Elicited Language (Moog and others, depending on level tested, available through CID ??)ages 3 to 11;11 years

——— Presentence; simple sentence; complex sentence structures

  • Teacher Assessment of Grammatical Structure (TAGS) from CID

———- Presentence TAGS-P; simple sentences (TAGS-S); Complex sentences (TAGS-C)

  • ? Looks like TAGS replaced GAEL
39
Q

Semantics- Standardized Tests for Deaf/ Hearing Impaired

A
  • Carolina Picture Vocabulary Test (Layton & Holmes, 1985)

—- For deaf children ages 4;0 to 11;6

  • Or less good: the Total Communication Receptive Vocabulary Test (Scherer, 1981)

—- For HI ages 3;0 to 12;0

40
Q

Test of Syntactic Structures

A
  • Sources give Test of Syntactic Structures (Quigley and others, 1978) & Maryland Syntax Evaluation Instrument (White, 1975)not in press
41
Q

Other Suggested Tests

A
  • Test of Problem Solving, as a test not only of ability to solve problems, but one’s ability to understand, solve and talk about daily social problems.
  • Sources give Reynell Developmental Language Scales

— Not normed on Deaf/HI, or even American children (UK)

  • MacArthur-Bates Communicative Development Inventory (multiple dates)
  • Series of questionnaires- more parental report
42
Q

Oral deaf children of hearing parents

A
  • Oral deaf children of hearing parents score better than total communication deaf or hearing parents
  • Geers, Spehar & Sedey (2002) review studies that indicate non-CI kids have greater language skills in sign over speech when in TC program
43
Q

Oral Communication or Total Communication?

A
  • Conner, et.al: 147 children, implanted 6 months- 10 years
  • OC vs. TC not significant except for speech

—- OC kids had better consonant production & progress

  • Time of implant significant

— TC kids better receptive vocabulary if implant prior to age 5 years

44
Q

Time of implant

A
  • TC kids better spoken vocabulary if implant prior to early elementary school
  • Both OC and TC kids better if implant as preschooler rather than elementary school years
45
Q

aural rehabilitation

A
  • Speech or sign for expressive mode
  • Language (receptive & expressive)
  • Phonological and phonemic awareness (for reading, writing, spelling)
  • Language can be either sign or verbal
  • Speech & Phonological/phonemic awareness require auditory discrimination
  • Work on all their communication
46
Q

DIP (Level 1)

A
  • Duration- tell the difference between the whistle of a train and the beep of a horn
  • Intensity- usually visual cue and something loud/something quiet
  • Pitch- slide (high to low) mountain (low to high) use lots of gestures to provide a lot of input
  • All provide information for phonological discrimination
  • Will assist in verbal production
  • Auditory-Verbal Training emphasizes listening & speech emphasized, but their own research suggests language is at or near hearing peers
47
Q

Training Variables (Sindrey, 2005)

  1. content
  2. context
  3. presentation
A
  • Content- effects what they can do.

— Familiarity

— Similarity /differences–discrimination

  • Context

— May increase chance that word might be confused with another word (if you don’t know the context)

— Can increases chance of discrimination and decrease misunderstanding

— Initially works with forced sets

  • Presentation

— Acoustic info (syllables, voiced vs. voiceless)

— & linguistic complexity

48
Q

Ling’s Approachto Speech Production

A
  • Voice on vs Voice off (first)
    1. Vary intensity (soft, loud, whisper, shout)
    2. Control duration: multiple vocalizations on single breath (needed for connected speech)
  • Pitch (second)
  • Oral vs. Nasal constraints (third)

— Often very nasal

  • Ling was the original verbal expert
  • Basis is DIP
49
Q

Ling Sounds

A
  • Ling sound- 6 ling sounds /ɑ/ /m/ /s/ /u/ /i/
    /ʃ/- sounds of continual duration, /s/ is important because it is a very important morphological marker and a frequent initial consonant cluster phoneme. /m/ is a low frequency visual sound
  • Daniel Ling- pioneer of auditory verbal
50
Q

Discrimination Training

A
  • Typically conducted with auditory only

— Use cloth screen to eliminate speech-reading

— [Keep in mind, that ultimately, communication is multi-modal]

  • Done after established DIP
  • Hierarchy of difficulty
51
Q

Sindrey (2005) Hierarchy

A
  • DIP
  • Contrast in # of syllables
  • Change consonants & vowels with same # syllables
  • Initial consonant, vary vowels after it
  • Rhyming words, by manner of production (maximum distinction is easier initially)

— see and bee- fricative vs stop

— pen and men- stop vs nasal

  • Final consonants, differ by manner of production
  • Final consonants, differ by voicing
  • Rhyming words, by voicing
  • Rhyming words, by place of production
  • Final consonants, by place of production
  • CAST- contrast for auditory and speech training

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