CAPD Final Deck Flashcards
Tell me about Evidence for a
Musician Speech-Perception-in-Noise Advantage in School-Age Children by Benítez-Barrera, C. R., Skoe, E., Huang, J., & Anne Marie Tharpe, A. M. (2022).
Study - Investigates whether musical training improves speech perception in noisy environments for school-age children. Recruited children with and without musical training (formal instruction). Children with musical training demonstrated better performance in speech in noise tasks which suggests an ability to focus on relevant signals. Musical training enhances auditory and cognitive functions likely due to practice with distinguishing pitch, rhythm, & timing.
Conclusion - Musical training enhances speech perception in noisy environments among school-age children. Tells us music education not only fosters artistic skill but also improves auditory & cognitive functions critical for communication.
Recommendations - Incorporating music into the school curriculum could support auditory and cognitive development. Music Intervention could benefit kids with auditory processing or speech perception challenges.
Tell Me about Blast Exposure and Auditory Processing by Gallun, F. J., Haley, E. G., Jorgensen, L. E., & Pratt, S. R. (March/April 2020).
Study - explore blast exposure on auditory processing & differentiate these effects from peripheral hearing loss and other injuries associated with blasts. Blast exposure often leads to damage in the peripheral and central auditory system resulting in problems with speech in noise, localizing, & processing complex auditory info. These people may exhibit normal thresholds but still report auditory difficulties, this is attributed to disruptions in central auditory processing rather than just peripheral damage. Frequently causes TBI which contributes to deficits in attention, memory, & executive function. Auditory impairments vary based on severity and proximity to the blast as well as susceptibility and comorbid conditions.
Conclusion - blast exposure can result in profound and long-lasting impairments in auditory processing. traditional audiometric tests may fail to detect these issues, emphasizing the need for specialized assessments to evaluate auditory processing and cognitive function.
Recommendations - Routine hearing tests should be supplemented with central auditory processing & cognitive evaluations for individuals with a history of blast exposure. Rehab programs should combine auditory training with cognitive therapy to address both sensory and cognitive deficits. Further studies are needed to develop targeted interventions and understand the mechanisms linking blast exposure to auditory processing deficits.
Tell me about Features of cognitive ability and central auditory processing of preschool children with minimal and mild hearing loss by Ji, H., Yu, X., Xiao, Z., Zhu, H., Liu, P., Lin, H., Chen, R., & Honga, Q. (2023)
Study - explores how minimal and mild hearing loss (MMHL) impacts the cognitive and auditory processing abilities of preschool-aged children.
Conclusion - Preschool children with MMHL exhibit subtle yet measurable differences in cognitive performance compared to peers with normal hearing. Areas affected include attention, memory, and executive functions, ability to localize sound, understand speech in noisy environments, and process complex auditory stimuli. While these children may not show significant delays in basic language milestones, their ability to develop advanced language skills may be compromised. Difficulty in distinguishing subtle sound differences (e.g., phonemes) can lead to later reading challenges. Cognitive deficits and auditory processing impairments interact, amplifying the challenges these children face in learning and communication. For example, deficits in working memory can exacerbate difficulties in processing and retaining auditory information. Early diagnosis of MMHL and its associated impacts on cognitive and auditory processing is essential for preventing long-term effects on academic and social outcomes. The study highlights the need for routine hearing screenings and comprehensive assessments of cognitive and auditory abilities in preschool-aged children.
Recommendations - Incorporate auditory training exercises. Provide access to hearing aids or other assistive listening devices, even for minimal and mild hearing loss. Educate parents. Collaborate among audiologists, speech-language pathologists, psychologists, and educators to provide comprehensive support tailored to the needs of these children.
Tell me about An auditory perspective on concussion by Kraus, N., & Krizman, J. (May-June 2018)
Conclusion - The auditory system is highly sensitive to brain function. Concussions, as a form of mild traumatic brain injury (mTBI), can disrupt auditory processing, even in cases where peripheral hearing appears normal. Individuals with concussions may experience difficulty processing complex sounds, such as speech in noisy environments, due to disruptions in how the brain integrates auditory signals. Temporal precision, or the brain’s ability to process the timing of sounds, is often compromised, affecting speech perception. Auditory brainstem responses (ABRs), which measure neural activity in response to sound, can reveal subtle deficits in the brain’s ability to process sound timing and frequency. ABRs provide objective data that can be used to detect and monitor brain dysfunction caused by concussions. Concussion-related auditory processing difficulties can manifest as challenges in understanding speech, particularly in noisy or complex listening environments, affecting communication and quality of life. These issues are often overlooked in traditional concussion assessments, which focus on symptoms like memory, balance, and headaches. Auditory processing assessments should be integrated into concussion evaluation protocols to capture the full scope of neural impact. Rehabilitation efforts can include auditory training to help retrain the brain’s processing abilities and improve functional hearing. Studying the auditory effects of concussion can contribute to a better understanding of brain plasticity and recovery. Auditory-based diagnostics, such as portable and non-invasive brainstem testing, offer promising tools for detecting and managing concussion-related neural dysfunction.
Recommendations - Include auditory processing tests, such as ABRs, as part of standard concussion evaluation protocols to identify subtle neural impairments. Develop auditory-based rehabilitation strategies, such as sound-based therapy and listening exercises, to address deficits in sound processing. Educate clinicians and audiologists on the auditory impacts of concussions to ensure comprehensive care and early detection of auditory deficits.Use auditory biomarkers to track recovery over time, providing objective measures of brain health and guiding treatment decisions.
Tell me about Benefits for children with language- and reading-related learning difficulties by Loo, J. H. Y., Bamiou, D., Campbell, N., & Luxon, L. M. (2010)
Study - Investigate how auditory processing interventions or accommodations might benefit children with language and reading difficulties particularly those linked to auditory processing disorders.
Conclusion - Children with APDs often face difficulty distinguishing and processing sounds, which can contribute to problems in phonological awareness, a crucial skill for reading and language development. Auditory training programs and assistive listening devices improved auditory discrimination and processing in children, leading to better language and reading outcomes. Combining auditory interventions with other sensory-based learning strategies (e.g., visual or kinesthetic aids) enhanced the overall effectiveness of interventions. Identifying APDs early and implementing targeted interventions were critical for improving academic and social outcomes for children.
Recommendations - Tailored interventions that address the specific auditory deficits in children with learning difficulties. Collaboration between audiologists, educators, and speech-language therapists is essential to provide comprehensive support.
Tell me about Individual differences in language
and working memory affect children’s speech recognition in noise by McCreery, R. W., Spratford, M., Kirby, B., & Brennan, M. (2017)
Conclusion - Children’s ability to recognize speech in noisy settings varies widely and is influenced not only by auditory factors but also by cognitive and linguistic abilities. Speech-in-noise recognition is a critical skill, particularly in educational and social settings. Stronger language abilities (vocabulary, syntax, and phonological awareness) help children better predict and decode speech in challenging auditory conditions. Children with weaker language skills may struggle more in noisy environments, as they have less linguistic context to rely on. Working memory plays a vital role in processing and retaining auditory information while filtering out background noise. Children with better working memory capacities can more effectively manage the cognitive demands of noisy environments. The study highlights the interaction between auditory processing, language, and working memory in determining children’s speech recognition performance in noise.
Recommendations - Assessing and addressing individual differences in these areas are crucial for supporting children, particularly those with hearing loss or auditory processing difficulties. Make sure you are providing holistic assessments, using targeted intervention, and technical support such as FM systems, and use a collaborative approach.
Tell me about Assisting Veterans with mTBI/PTSD by Mehta, Z., Thorstad, T., & Hale, T. (2019, June)
Conclusion - Many veterans experience both mTBI and PTSD due to their service-related experiences. These conditions often co-occur, making it challenging to distinguish between their symptoms.
Symptoms of mTBI, such as headaches, memory problems, and difficulty concentrating, often overlap with PTSD symptoms like hypervigilance, anxiety, and emotional dysregulation. Accurate diagnosis can be difficult because of the overlapping symptoms and the subjective nature of many complaints. Comprehensive assessments are recommended, including neuropsychological testing, interviews, and self-report questionnaires to identify the primary sources of impairment. Veterans with mTBI/PTSD often experience difficulties in cognitive functioning (e.g., attention, memory), emotional regulation, and interpersonal relationships. These challenges can affect their reintegration into civilian life, including employment and social relationships. Interdisciplinary Care: The article emphasizes the importance of a multidisciplinary approach, involving neuropsychologists, psychiatrists, audiologists, and occupational therapists. Cognitive Rehabilitation: For mTBI, cognitive training and strategies to compensate for memory and attention deficits are highlighted. Trauma-Focused Therapy: Evidence-based therapies such as cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are effective for PTSD. Symptom Management: Addressing secondary symptoms such as sleep disturbances, headaches, and chronic pain is also crucial. Social support and family involvement play critical roles in recovery. Education for family members about mTBI and PTSD can improve understanding and communication. The authors discuss the availability of resources through organizations such as the Department of Veterans Affairs (VA), which provides specialized programs for veterans with these conditions. Assistive technologies, vocational rehabilitation, and peer support groups are highlighted as valuable tools for reintegration.
Recommendations - Treatment should be individualized based on the veteran’s specific needs, with flexibility to address the evolving nature of their symptoms. Early intervention and ongoing care are essential for better outcomes. Increasing awareness among healthcare providers about the unique needs of veterans with mTBI/PTSD is critical for improving care.
Tell me about Auditory processing performance of the middle-aged and elderly: Auditory or cognitive decline? by Murphy, C. F. B., Rabelo, C. M., Silagi, M. L., Mansur, L. L., Bamiou, D. E., & Schochat, E. (2018)
Study - Explored if declines in auditory processing in older adults are primarily due to age-related changes or if it is influenced by cognitive decline. Determined auditory processing difficulties are not solely due to peripheral hearing loss but also involve cognitive decline. The Elderly showed poorer performance on auditory processing tasks compared to the middle-aged - particularly speech in noise & temporal processing. Cognitive factors contribute to auditory processing performance, particularly for tasks requiring complex integration.
Conclusion - Auditory processing problems are not solely due to peripheral hearing loss but also cognitive decline. When assessing auditory processing issues in older adults consider auditory & cognitive factors.
Recommendations - Audiological evaluations should include cognitive assessments for older adults. Interventions may benefit from targeting auditory training and cognitive strategies to improve auditory processing abilities.
Tell me about On the clinical entity in audiology: (Central) Auditory processing and
speech recognition in noise disorders by Vermiglio, A. J. (2014)
Study - examines the concept of auditory processing disorders (APDs), particularly focusing on speech recognition in noisy environments, and questions whether APD can be considered a distinct clinical entity in audiology.
Conclusion - Vermiglio discusses the criteria for a “clinical entity” in medical and audiological practice, which include a clear and distinct pathology, associated symptoms, and effective diagnostic and treatment protocols. He questions whether CAPD meets these criteria, particularly concerning speech recognition in noise (SRN).SRN difficulties are often attributed to CAPD, but the author argues that SRN challenges might instead reflect broader cognitive, linguistic, or hearing issues rather than a distinct auditory processing deficit. Variability in SRN performance may be influenced by factors such as language skills, working memory, and attention, rather than solely central auditory processing.The article highlights the lack of standardization and consistency in diagnosing CAPD, leading to potential misclassification of individuals. Tests used for diagnosing CAPD often overlap with those measuring cognitive and linguistic abilities, raising questions about their specificity to auditory processing.Vermiglio emphasizes that SRN difficulties are likely multifactorial, involving peripheral hearing, cognitive processes, and language abilities. The author advocates for a more holistic approach to understanding SRN challenges, rather than attributing them solely to CAPD. The article calls for a re-evaluation of the concept of CAPD as a distinct clinical entity and suggests focusing on functional outcomes, such as improving communication in noisy environments, regardless of the underlying cause. Vermiglio recommends a broader, multidisciplinary perspective that considers the interaction of auditory, cognitive, and linguistic factors in assessment and intervention
Recommendations - Use comprehensive evaluations that account for cognitive and linguistic contributions to SRN performance. Shift from diagnosing CAPD as a standalone entity to addressing practical communication challenges in noise. Incorporate expertise from audiologists, speech-language pathologists, and cognitive scientists to create effective intervention strategies.
Tell me about Using different criteria to diagnose (central) auditory processing disorders: How big a difference does it make? by Wilson, W. J., & Arnott, W. (2013)
Study - examines how the application of varying diagnostic criteria affects the identification and diagnosis of (Central) Auditory Processing Disorders (CAPD). The study highlights the lack of standardization in CAPD diagnostic practices and its implications for clinical and research contexts.
Conclusion - CAPD diagnosis lacks a universally accepted standard, with different clinicians and researchers applying varying criteria to interpret test results. The authors explore how changes in diagnostic criteria, such as the number of failed tests or the severity of the deficits required, impact diagnosis rates. The study involved a retrospective analysis of test data from individuals assessed for CAPD. The researchers applied different diagnostic criteria to the same dataset to determine how diagnosis rates varied. Diagnosis rates fluctuated significantly based on the criteria used. For example: Stringent criteria requiring failure on multiple tests yielded lower diagnosis rates. Lenient criteria allowing failure on fewer tests or emphasizing certain domains (e.g., auditory discrimination) resulted in higher diagnosis rates. These discrepancies highlight the subjectivity in current CAPD diagnostic practices. Variability in diagnosis can lead to inconsistencies in treatment recommendations, with some children receiving interventions unnecessarily while others may be overlooked. The study underscores the need for standardized diagnostic protocols to ensure accurate and equitable identification of CAPD. Many tests for CAPD overlap with assessments for other conditions, such as language impairments or cognitive deficits, complicating differential diagnosis. The reliance on behavioral tests, which depend on patient cooperation and attention, introduces variability in results.
Recommendations - Develop and adopt consistent diagnostic guidelines to reduce variability and improve the reliability of CAPD diagnoses. Incorporate input from audiologists, speech-language pathologists, and psychologists to distinguish CAPD from related conditions. Focus on functional impairments, such as difficulties in real-world listening environments, rather than strictly test-based criteria. Promote research to establish the validity and reliability of various diagnostic tests and criteria.
What is CAPD?
complex, heterogenous, bottom up perceptual disorder. it affects the auditory system leading to a sensory processing problem that impacts listening, spoken lanauge, comphrension, and learning
4 subtypes of (C)APD
lexical decoding, tolerance fading memory (TFM), organizational deficits and integration deficits
lexical decoding deficits
difficulty processing words verbal and written resulting in porr reading and spelling. the left posterior temporal lobe is involved
tolerance fading memory
difficulty listening in noise and recalling information resulting in weak expresssive language and poor handwriting. The frontal and anterior temporal lobe with a small region of the parietal lobe are involved.
organizational deficit
poor auditory sequencing or planning resulting in problems with sequential information. The pre and post central gyri with anterior temporal lobe are involved.
integration deficit
problems integrating acoustic and linguistic information. the corpus callosum is involved.
What is developmental APD?
cases presenting in childhood with normal hearing and no other known etiology or potential risk factors
What is acquired APD?
cases associated with a know post natal event that could plausibly explain the APD
What is secondary APD?
cases where APD occurs in the presence or as a result of peripheral hearing impairment
Someone with dichotic processing problems would present with? Which tests assess dichotic processes?
present : speech in noise issues, difficulty in complex environments, difficulty with rapid speech and difficulty following directions
tests : dichotic digits, competing sentences, SSI CCM, & SSW
Someone with temporal processing problems would present with? Which tests assess temporal processes?
present : difficulty with timing cues, difficulty understanding fast speech, difficulty following rhythms and patterns
-leading to difficulty reading and writing
tests : GIN, RGDT, DPT, PPST
Someone with binaural interaction problems would present with? Which tests assess binaural interaction?
present : difficulty localizing, difficulty in noise and spatial awareness issues
tests : MLD & auditory fusion
Someone with auditory closure problems would present with?
Which tests assess monaural low redundancy speech/auditory closure processes?
present : difficulty with muffled speech or accented speech, reverberant issues, difficulty with phone conversations and may report missing information
-impacts phonemic processing and suprasegmental cues therefore impacting language learning
tests : filtered words, time compressed sentences, SSI ICM, speech in noise
What tests assess the brainstem?
PSI, SSI ICM, MLD (lower brainstem),
What tests assess the corpus callosum/cortex?
dichotic digits, competing sentences, SSW
Which CAPD test result patterns help with a definitive diagnosis?
unilateral deficit = tells us they understood the task so the problem was not due to linguistic, cognitive, or attention disorders
unilateral deficits are a huge red flag for CAPD especially if it is a left ear deficit
Who is eligible for a diagnostic CAPD evaluation?
- age
- hearing
- cognition
- ADHD
- speech and language issues
- autism
age : 7+
hearing : normal and no ME dysfunction
cognition : intelligence should not be a factor (meaning it needs to be ruled out)
ADHD : must be ruled out
S/L : minimum language should be at least 6 years or within a year of chronological age
autism : must be ruled out
Lax criteria
They have the condition if they fail one of the tests. Good sensitivity but poor specificity.
Intermediate criteria
To get a diagnosis they need abnormal performance on at least 1-2 tests
Strict criteria
They need to fail all tests to get a diagnosis. Good specificity but poor sensitivity.
What is a 504 ?
504 = accommodations for students so they can perform at the same level as their peers. can include educational or general accommodations (wheelchair ramps, blood sugar monitors, keyboard for taking notes, etc).
section 504 of the rehabilitation act of ADA
What is an IEP?
stands for individualized education plan. federal mandate to provide educational services to those who need it - only available to small subset of students that require more than a level playing field aka they need significant remediation and assistance.
(individuals with disabilities act - IDEA)
Does (C)APD qualify for an IEP or a 504 and why?
504, while it can be considered a disability that affects learning, it may not necessarily require the level of specialized instruction typically provided under an IEP
Bottom-up processing
information from input like sensory information. our senses allow us to interpret things around us. data driven.
Bottom up strategies
auditory training, enhanced signal audibility such as FM/remote microphone, environmental modification
Top-Down Processing
guided by higher-level cognition. uses our experiences and expectations. conceptually driven.
top down strategies
language strategies, cognitive strategies, metacognitive strategies and classroom instructional/learning strategies
Controversy: Is (C)APD modality-specific or supra-modal?
according to experts, CAPD is modality-specific perceptual dysfunction meaning that the problems are primarily in the auditory system because of this, it can be differentiated from other conditions where others might be across multiple senses
but there is a controversy that capd has multiple modalities that are impaired arguing for supramodal problem this would move the disorder from the audiologic to the psychological domain and maybe outside of the scope of practice for audiologists
what does supramodal mean
processes information that transcends individual sensory modalities, allowing integration across different senses
understanding the meaning of a word whether it is heard or read
brain processes that operate across different sensory modalities (not specific to any one sense and can integrate information from various sources)
like sight and sound
what does modality specific mean
processes information specific to a single sensory modality
processing auditory information only, processing visual information only etc.
brain processes tied to a particular sensory modality (hearing, visual etc.)
Why is CAPD controversial?
Lack of gold standard, sensitivity & specificity of tests, no standardized test battery or universally accepted standard for diagnostic criteria, poor test performance not consistent with real-life performance, influence of language & attention &
cognition
what are the 4 main categories for managing CAPD
auditory environment, auditory training, music training and training with phonemes/words
Why is ANSD a differential diagnosis for CAPD?
they have a lot of the same risk factors and both don’t have 1 single cause. they are both peripheral disorders with central implications. however ANSD is modality-specific & it is not secondary to cognitive, linguistic, or related factors
Why is ADHD a differential diagnosis for CAPD?
ADHD is a top down disorder & CAPD is a bottom up disorder.
You can tell which one the patient had by using the digit span test in auditory and visual modalties. If they do poorly on vision then it would indicate ADHD.
Why is DLD (developmental learning disability) a differential diagnosis for CAPD?
ferguson et. al. compared performance of children with either a clinical diagnosis of DLD or (C)APD on tests of intelligence, memory, language, phonology, literacy and speech intelligibility and found no differences between the two groups of children. they concluded that children were diagnosed based on their referral route vs. actual differences
Why is dyslexia a differential diagnosis for CAPD?
dyslexia affects reading, spelling, writing, and phonological processing
CAPD affects understanding in noise and following verbal instructions
what is dyslexia?
learning disorder than affects reading and writing skills, it does not impact intelligence
What is ADHD?
neurobehavioral childhood disorder that primarily affects children and often continues into adulthood that is characterized by inattention or hyperactivity-impulsivity
What are the 2 criteria to diagnose ADHD?
A1/inattention, A2/hyperactivity or a combination of A1 and A2
How is ADHD diagnosed according to the DSM-V?
if six or more symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and negatively and directly impact social and academic/occupational activities
-or for combination of both, present for 6 months
What is criterion 1 aka inattention symptoms?
fails to give attention to details/makes careless mistakes, has difficulty sustaining attention in tasks or play activities, does not seem to listen when spoken to directly, does not follow through on instructions/fails to finish schoolwork or chores, often avoids/dislikes tasks requiring sustained mental effort, often easily distracted by extraneous stimuli, often has difficulty organizing and activities
what is criterion 2, aka hyperactivity symptoms?
fidgets with or taps hands or feet or squirms in seat, often leaves seat in classroom when remaining seated is expected, often runs about or climbs in situations where it is inappropriate, unable to play or engage quietly in leisure activities, often talks excessively, often blurts out answers before questions have been completed. often has difficulty awaiting turn and often interrupts/intrudes on others
What will it look like if they have a combo of A1 & A2?
predominantly inattentive presentation (if criterion A1 is met but criterion A2 is not met for the past six months) or predominantly hyperactive-impulsive presentation (if criterion A2 is met but criterion A1 is not met for past six months)
What is ANSD?
a disorder of auditory dssynchrony of the 8th nerve ; timing is impacted.
What tests will be normal for ANSD?
OAE & a recordable cochlear mircrophonic (CM)
what tests will be abnormal for ANSD?
ARTs, ABRs, ECochG and MLDs aka anything having to do with the 8th nerve
What are the common risk factors for ANSD?
family history, hyperbilirubinemia, infection or immune disorders
Synaptopathy (Hidden Hearing Loss)
acquired condition that permanently interrupts synpatic communication b/w IHC & CN8 fibers well before HL is diagnosed. typcially seen with NIHL & aging.
Clinically - decresed wave 1 amplitude with normal ABR thresholds, speech in noise probs, tinnitus, hyperacusis
Cerebrovascular Accidents (CVA) most common cause & risk factors
most common cause is a a stroke. risk factors - high blood pressure, heart disease, diabetes, smoking, aging.
CVA ischemia
caused by thrombus (blood clot), abstructs blood flow. may occur in any large cerebral blood vessel causing brain cells to ultimately die. functions in that area are diminshed or lost
CVA embolus
small blood clot that has disloged from larger clot. usually from the heart following a heart attack (from one of the carotid arteries). can happen on transatlantic flights.
if the clot is small is may pass and the patient recoverts fully. these are called transient ischemic attacks (TIA) and may eventually lead to a full blown CVA
CVA hemorrhage
when blood vessel in the brain ruptures and bleeds . most common cause it super high blood pressure but can also be caused by aneuryms and arteriovenous malformations. less common that ishemic stroke but can cause - damage to surrounding neural tissue or cut off blood supply to distal areas.
What is a Concussion? Causes?
diffuse non pentrating TBI caused by enternal force such as bump, blow, jolt to head, or being hit by something that causes the brain to rapidly move back and forth
who is most likely to get a concussion?
athletes & military
How are concussions & PTSD related?
when concussions are caused by blast exposure other injuries can mask the concussion for example PTSD. PTSD also leads to sleep disturbances or anxiety so it can be difficult to determine if the blast resulted in PTSD, a concussion, or both
How are concussions & the auditory system related?
concussions can impair listening abilites and the ability to process auditory information
4 categories of concussion symptoms
cognitive impairments (concentrating, short term memory), physiological impairments (blurred vision/hearing problems), emotional problems, sleep disturbances
Chronic traumatic encephalopathy (CTE); what causes it, clinical presentation
rare neurodegenerative injury that does not have symptoms until years after the repeated head injuries (happens a lot in football players). It can lead to mood disorders, short term memory loss, depression, congnitive decline and dementia.
What is central deafness? causes?
a rare disorder of the CANS with generally preserved peripheral auditory function but inability to perceive speech and/or environmental sounds
most commonly secondary to CVA or head trauma meaning an acquired disorder
What is the central deafness site of lesion
bilateral involvement of the primary auditory cortex (heschl’s gyrus)
-could also affect the associated auditory areas, subcortical areas, parietal lobe, frontal lobe, MGB or pons
what should be done in order to diagnose central deafness
a complete peripheral audiologic assessment, behavioral (C)APD tests, evoked potentials, MRI and CT scan
-pure tones, speech, immittance, OAEs
in terms of an audiological assessment, what results are expected with central deafness
varying severity of tones, with speech they may not be able to perform the test or will appear inconsistent with pure tones, immittance and OAEs are consistent with hearing
Central deafness exclusionary diagnosis includes
Nonorganic HL, CAPD, dementia, tumors, ANSD
depending on the etiology of central deafness, these patients may not be able to perform ……
(C)APD tests
-due to adverse effects on attention and memory
in terms of evoked potentials for central deafness, what could be expected
ABR is generally normal and mid to late responses may be abnormal dependent on the site and size of lesion
with central deafness, what is the management dependent on
etiology
what are some management strategies for central deafness
speech and language therapy, auditory training and the usage of visual cues/devices to communicate
-HAs are generally not helpful
-patients that experienced central deafness due to vascular accidents may resolve on their own
over time, patients with central deafness will ….
recover at least some auditory function
why is NOHL a differential dignosis for central deafness
they both show inconsistencies between pure tones and speech HOWEVER central deafness will also show difficulty with environmental sounds and not all patients with NOHL do that
-need to be aware that they present very similar because they do not appear consistent with results
why is CAPD a differential diagnosis for Central deafness
central deafness is generally acquired, meaning will likely show in adults whereas (C)APD is generally seen in mainly children
-also (C)APD is not as severe
why is dementia a differential diagnosis for central deafness
both have adult onset and sometimes people with dementia may appear with NOHL
-important to test cognition as well
why are tumors a differential diagnosis for central deafness
depending on where cortical tumors are, they can cause a change in personality and attention and a lot of times it can appear as a sensory change tumor which can appear like central deafness
-adds the importance of imaging
CAPD risk factors for older adults
peripheral factors, cognitive factors and central auditory factors
peripheral factors
the integrity of the peripheral auditory system plays a significant contribution to listening and related activities
-discussing cross modal reorganization, changes with tonotopic organization and hidden HL
cross modal reorganization
a cortical compensation that is seen in deafness and HL when the auditory cortex is re-purposed by visual or somatosensory modalities
what can changes in tonotopic organization lead to
degraded decoding of HF spectral cues and degrading temporal encoding of acoustic signals
-leading to disruption of auditory processing relying on spectral and timing such as speech
cognitive factors
ease of language learning understanding (ELU) model, working memory and the resource allocation model
ease of language understanding (ELU) model
a theoretical model that has been developed to describe the relationship between cognitive processes and speech understanding
how does working memory play an important role in auditory processing
the faster the task is completed then the less the decay and more successful the performance is due to it being a limited capacity system
-individuals that can perceive information rapidly will have more working memory available
resource allocation model
presence of perceptual deficits caused by a peripheral pathology results in the need for greater resources to be allocated to auditory processing
-in other words, the more the HL the greater resources are allocated for getting the proper information
central auditory factors
there is a decrease in neurons with age, especially in the superior temporal gyri, precentral gyri, areas around heschel’s gyrus important for speech processing, decrease in volume of the ventral cochlear nucleus after the 5th decade
-decrease in volume is associated with decreased myelination and blood vessels
with central auditory factors, it is important to discuss the corpus callosum. what age related changes are seen?
with age related changes, they show poor performance on binaural integration and dichotic listening tasks
-can also represent a RE advantage again (meaning we see it both with aging at the young age and old age)
CAPD assessment in older adults
case history, hearing evaluation, tests for language and phonological processing, (C)APD behavioral tests, cognitive/psychological evaluation and physiologic tests
CAPD management in older adults
both bottom up and top down approaches, rhyming activites and proper counseling
with older adults, we can only conduct (C)APD assessments with age appropriate norms however why is this a concern
older adults are not homogenous so it becomes difficult to have norms for this age as everyone varies greatly already
why may older adults benefit from rhyming activities
may help regain some lost processing abilities
what is the importance of proper counseling
can provide realistic expectations and better acceptance
what is a clinical entity?
denotes a concept of uniformity on patients
-ultimate reference for the entire field of medicine
-facilitates diagnostic and therapeutic approaches to individual patients
according to vermiglio, what are the 5 criteria essential to be an entity
does it possess an unambiguous definition, does it represent a homogenous patient group, does it represent a perceived limitation, does it facilitate diagnosis and does it facilitate intervention
why does Vermiligio say CAPD is not a clinical entity
- no, no agreed upon definition and it varies based on group
- no, everyone presents differently
- this is not super clear according to him, failure on behavioral tests does not indicate that the patient actually has the diagnosis of (C)APD
- there is no gold standard in order to know if the results are accurate of (C)APD
- intervention is often deficit specific and since (C)APD has not gold standard there is no clear intervention
Tell me about sound localization & how these deficits can affect academics
difficulty in spatial awareness, following multi-speaker conversations and maintaining attention in a classroom
Tell me about temporal processing & how these deficits can affect academics
Temporal processing issues can lead to problems with auditory discrimination or resolution. This results in problems with reading, spelling, and writing.
Tell me about auditory closure & how these deficits can affect academics
Deficits may affect understanding in noise affecting language learning and academic success.
Tell me about auditory figure ground & how these deficits can affect academics
difficulty understanding speech in noisy environments
leading to challenges in classroom discussions or group learning
Tell me about auditory analysis & how these deficits can affect academics
challenges with decoding
crucial for reading and spelling
reading difficulties
Tell me about auditory memory & how these deficits can affect academics
poor ability to follow multi-step verbal instructions or remember sequences
impacts classroom performance
Tell me about frequency resolution & how these deficits can affect academics
May affect phonemic processing, suprasegmental cues, and therefore language learning
What are the norms for MLD short version and MLD long (recorded) version?
short = 10 dB or greater
long = 14 dB or greater
What are the norms for GIN (total % and ms)?
age 8-11 = 52%
ages 12+ = 54%
ms norms are less than 8 ms
What are the norms for RGDT?
below 20 ms is normal anything greater is concerning
what is the role with managing the auditory environment
recommending and managing assistive devices
-gain medical clearance prior to a personal FM fitting
-permission from the parents to use the FM in the school (if received from the school district)
-run trials with FM systems through an evaluation period of 30-45 days
what can be done in order to manage the auditory environment
hearing assistive devices, speaker changes, manage ambient noise levels, monitoring SNRs and reverberation time, using signal enhancement systems and HAs
examples of modifications that can be done to manage ambient noise levels
double paned windows, noise control devices on heating/cooling, lowering ceiling levels, carpeting, curtains, use of bookcases
what are the two main types of signal enhancement systems
individual FM systems (directly to the child’s ear) and digital sound distribution systems (throughout the classroom)
auditory training
acoustic conditions and/or tasks that are designed to activate auditory and related systems in such a manner that their neural based and associated auditory behavior are altered in a positive way
auditory training : preschool intervention
goal is to expose the child to experiences that require carful listening to prevent disruption of communication, learning and social development
-ex. playing games such as musical chairs (just exposing to language in general)
auditory training : school age intervention
goal is to focus on strategies and techniques that reduce communication and learning disabilities
-ex. figure ground training to apply listening in noise skills
auditory training : adult intervention
goal is to focus on compensation and relearning rather than recovery of function
music training
thought to improve nervous system function by focusing attention on meaningful acoustic cues
-kraus et. al. found that children with a history of music training had a stronger distinction of stop consonants, a neural mechanism linked to reading and language skills``
music training has been shown beneficial for ……..
disorders such as autism, ADHD, language therapy for aphasia following a stroke
training with phonemes and words
useful for children with poor phonemic decoding, spelling and reading skills such as fast forward and lindamood bell
-benefits occur over time
computer based auditory training falls under auditory training however it is …….
adaptive
-meaning they need to gain the child’s attention
with CBAT, what are some components we need to consider with the stimulus
-synthetic speech, natural non speech or synthetic non speech
-focused (active) attention or unfocused (passive attention)
synthetic speech
allows for more accurate control of parameters such as duration and intensity
natural non speech (environmental)
sounds that are used less frequently because there is no cognitive challenge and it is difficult to maintain the interest of the listening
-lacks inherent meaningfulness so often is accompanied by pictures
synthetic non speech
including tones or noise burst and typically is the least interesting stimuli for listeners
-more precise training in discrete frequency, intensity and temporal domains
focused (active) attention vs. unfocused (passive) attention
with focused attention requires the listener to actively direct attention to specific information in the stimuli
-active provides a reward for attending, increasing the likelihood of active and focused attention
what are some popular CBAT programs
Fast ForWard, Earobics, Lindamood Bell
cochlear microphonic (CM)
reverse polarity (rarefaction vs. condensation)
-may have longer than normal amplitude and can ring longer mimicking an ABR
SCAN-3 C age
5-13 except for gap detection thats 8-13
ACPT age
6-12
PSI age
3-6
format 1 = 3-4
format 2 = 5-6
DPT age
9+
GIN age
7+
PPST age
7+
SSI age
8+
dichotic digits age
5+
LiSN-S age
6-30
MLD AGE
5+
RGDT age
5-12
SSW age
5-70
CAPD differential diagnosis
central deafness, ANSD, ADHD, DLD, dyslexia
