Aural Rehab - Exam 2 Flashcards
What do HA’s do?
amplify sound enough to compensate for loss
Cochlear Implants
implantable electronic devices that convert sound energy to electrical energy which directly stimulates the auditory nerve
- hair cell damage is too severe
1990 FDA approved….
cochlear implants for children
1984 FDA approved….
House/3M single cochlear implant
Adult CI team
surgeon and AuD
Adult Implant Criteria
Moderate to profound bilateral sensorineural loss, little or no benefit from HA’s (50% or less on WR test)
CI Critical Factors
Age of onset, duration of profound loss, HA use and quality, support of family and realistic expectations
Medical CI Criteria
12+ months of age, able to tolerate general anesthesia/recovery process, patent cochlea on imaging studies
Pediatric CI Team
Parents, educators, surgeon, AuDs, SLPs, child psychologist, social worker
CI Criteria (12-24 months)
profound bilateral SNHL, limited benefit from appropriate HA, lack of progress in auditory skill development with amplification and aggressive intervention.
exception to 1 year is meningitis
CI Criteria (25 months - 17 years)
severe-profound bilateral SNHL, plateua in development of auditory skills, WR less than 30%
CI Components (Internal and External)
Internal receiver and electrode array; microphone, connecting cables, speech processor and transmitter
CI’s programmed using these parameters
Dynamic range
Loudness balancing
Pitch matching
Bilateral CIs have…
better performance in noise, improved localization ability, positive reports from patients/parents and less vulnerable to performance problems
Hearing Assistance Technology Systems (HATS) and Assistive Listening Devices (ALD) are used to address…
face to face communication, electronic media, telephone use and environmental stimuli
FM Units
The speaker wears a microphone and their speech is sent to the listener wirelessly, by a frequency modulating signal
Disadvantages: subject to interference, expensive, repairs, need to have correct channels in the classroom, speaker must remember to turn off the microphones when having private conversation.
Lipreading
process of recognizing speech using only the visual speech signal and other visual cues, such as facial expressions.
Speech reading
is speech recognition using both auditory and visual cues, facial expressions and gestures – it includes lipreading, but is much more!
Visual speech signal
one of the most effective means for persons with hearing loss to enhance their recognition of speech language
Lipreading variable that have predictive power
Cognitive skills
Age
Type of hearing loss
People with perfectly normal hearing often rely on…
speechreading
Residual Hearing
limiting hearing ability can assist in speech recognition when combined with visual cues.
Combining even some sound with visual cues shows why people with profound hearing loss are so dependent on hearing aids
Speechreading is affect by… (4)
Talker
Message
Speechreading environment and communication situation
Speechreader
Vision-Only speechreading
typically comprise of the talkers head ans shoulders with the talker and patient head on
Audition-Plus-Vision speechreading
enhanced by comparing speech recognition scores in vision-only vs audition-plus-vision conditions
Martha Emma Bruhn (1902)
rapid syllable drill
rapid phrase recognition
Edward Nitchie (1912)
Rarely used drills
Used sentences and stories
Contextual cues
Cora Kinze (1917)
analytic and synthetic
Jena Method (1925)
Used memetic
Kinesthetic
Focused on the mouth movements of the instructor while speaking the training materials at the same time
Implicit Conversational Rules
Attend to communication partner with interest
All people participate in exchange
Participants choose topic and play conversational role
Turn-taknig amongst conversational partners
Participants stay within topic and relevance
Share in the conversation
Be clear and succinct
Message tailoring strategy
messages can be tailored to elicit a more desirable result
influence the message
Constructive strategies
optimize the listening environment for communication
Adaptive strategies
methods of counteracting maladaptive behaviors that stem from hearing loss
Inappropriate behavioral mechanism for coping with the difficulties caused by hearing loss
-relaxation, deep breaths
Maladaptive strategies include
bluffing, social withdrawal, dominating conversations, self pity, hostility, anxiety
Anticipatory strategies
method of preparing for communicating interaction
reading a book or synopsis before a movie, play
etc
Two types of repair strategies
Receptive: used by listener when they have not understood the message
Expressive: used by the talker when their utterance is unintelligible and listener cannot understand it
Expressive repair strategies
Understanding child reduced articulation and/or language skills Repeating message using best speech Rephrase Slowing down speech rate Using shorter sentences etc
Topic shading
when new emphasis is derived from an ongoing topic of conversation such that the topic remains the same but relevant details shift
Nonspecific repair strategies
Use of “What? huh? “ are non-specific repair strategies
feature explicit instructions for clarifying the conversation
Passive conversational style
avoids misunderstanding/ conflict
Aggressive convo style
exhibits hostility or intimidating demeanor
Passive aggressive conver style
manipulates conversation for later vengeance
Assertive conve style
communicates effectively, finds solutions
Interactive
use cooperative tactics, share responsibility for advancing conversation
Noninteractive
features a passive conversational style
Dominating
aggressive behavior, takes extended speaking turns, interrupts, dominates
Infrared Systems
light waves. Transmitter sends signal encoded in infrared light rays to amplifier/receiver.
Induction Loops
wire encompasses a designated area, converts sound into electric energy and into the loop. Energy is picked up by a telecoil
Induction Loops (Adv. and Disadv.)
Adv: accessability, freedome of movement, inexpensive, telecoils are universal
Disadv: need a receiver, interference, may need to sit in designated area
Wired Systems
connection by wire. Direct audio input or telecoil. can be expensive. mobility, consistent sound.
Ambient Noise
noise present in unoccupied room
Reverberation
echoes caused by sound bouncing off surfaces such as walls, floors and ceilings
Background Noise
undesirable noise that masks the unwanted auditory signal
Devices to help with environmental sounds (2)
Alerting devices (bed shaker, multi-modality alarms - e.g., doorbells = flashing lights)
Computer Based Technology (texting, video messaging)
TTY (text telephone/telephone typewriter)
telephone in acoustic couplers
So the sender needs to type the message on a keyboard, the letters transformed into electronic pulses that are sent over the wire to the recipient TTY where the pulses are returned to letters on an LED screen
most common complaint from people is that they can detect sound but can not __________, especially in the presence of __________ _______
understand
background noise
Auditory Training
instruction designed to maximize a patient’s residual hearing or electrical hearing.
Analytic Auditory Training
emphasizes recognition of individual speech sounds or syllables (e.g., words)
one must perceive each of the basic parts of speech before the whole can be identified
Synthetic Auditory Training
emphasizes understanding of meaning of utterance, not the identification and comprehension of utterance (e.g., sentence)
perception is the most important thing
Problems faced by people with hearing loss
Decreased audibility, dynamic range, frequency resolution, temporal resolution, combination deficits
Candidacy for Auditory Training
those who recently had a change in hearing status. although all with a HL can benefit.
Brain Plasticity
the brain’s ability to change as a result of experience, behavior, environment and sensory deprivation or stimulation
Implementing an AT program
patient should be fitted with appropriate listening devices ahead of time, AT is increasingly computerized, future AT will be more engaging due to technology
4 types of AT programs
Phoneme, Word, Sentence and Cognitive-Skill Based
Phoneme Based AT
Provides building blocks which can be generalized into larger speech units; bottom-up processing. nonsense syllables.
Word Based AT
meaningful speech units only. ID word spoken from a closed set of choices
Sentence Based AT
Sentences; top-down processing
Cognitive-Skill Based AT
working memory training; selective attention training
AT to Improve Music Perception
musical feature approach - structural features of music
whole song approach - familiar melodies, simple songs, music videos
Benefits of AT
Speech recognition, music perception
