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
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)
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
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
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
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
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
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
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
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
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**
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.
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
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
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
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
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)
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)
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
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
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
Disordered Babbling
- 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
Gesture
- 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
Sign Language 1
- 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
Sign Language 2
- 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
Speech and Voice
1. Phoneme Production errors
2. Vocal Quality
1. Omissions
Distortions
Substitutions
2. Breathy
Harsh
Glottal fry to falsetto
Variable loudness
Hyper/hyponasal
Throaty (little oral cavity resonance)
Cul de sac (little oral cavity resonance
30
Speech (from Pratt, 2005) 1
- 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
Speech (from Pratt, 2005) 2
- 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
Speech and Voice
1. Prosody and Pitch
2. Rhythm and Timing
1. Flat, monotone
2. Improper stress
- Improper pausing
- Over articulation (lack of co-articulatory changes)
33
Suprasegmental ability and hearing impaired
- 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
School and HI
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
Deaf and Hearing Impaired: Speech and Language Assessment 1
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
Deaf and Hearing Impaired: Speech and Language Assessment 2
5. Semantics of preferred communication mode
6. Pragmatics
7. metalinguistic skills
- judging grammaticality of utterances
- paraphrasing skills
- metaphors and other figurative language
8. Suprasegmental ability
- timing
- rhythm
- intonation contours
37
Rhode Island Test of Language Structure
- 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
Grammatical Analysis of Elicited Language
- 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
Semantics- Standardized Tests for Deaf/ Hearing Impaired
- 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
Test of Syntactic Structures
- Sources give Test of Syntactic Structures (Quigley and others, 1978) & Maryland Syntax Evaluation Instrument (White, 1975)not in press
41
Other Suggested Tests
- 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
Oral deaf children of hearing parents
- 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
Oral Communication or Total Communication?
- 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
Time of implant
- 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
aural rehabilitation
- 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
DIP (Level 1)
- 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
Training Variables (Sindrey, 2005)
1. content
2. context
3. presentation
- 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
Ling's Approachto Speech Production
- 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
Ling Sounds
- 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
Discrimination Training
- 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
Sindrey (2005) Hierarchy
- 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
