Exam 1 Flashcards
Describe the clinical barriers healthcare providers might not realize impact patient outcomes
○ Clinical setting barriers
○ Quality of experience barriers
○ Communication mismatch b/w patient and audiologist
○ Technocentric barriers
Clinical Barriers
Clinical setting barriers
- Parking
- Office Convience
- Surrounding Enviorment
- Apperance of Office
Clincial Barriers
Quality of experience barriers
- Ease of making appointment
- staff knowledge/helpfulness
- Wait time
- perceived priorities of staff
Clincal Barriers
Communication mismatch b/w patient and audiologist
- Offer informatinal counseling when personal adjustment counseling is needed
- Does it investigae a patients personal activity limitation, participtaion restictions, state of mind or individual communcation needs?
Clinical Barriers
Technocentric barriers
■ Offers only product-based solutions
Define Cross-modal reorganiztion
Is when the brain adapts by reallocating function that is typically associated with one sensory modality to another sensory modality
Define Encoding
is when the brain converts sensory input into neural siganls or patterns to stored, processed and later recalled as memeories!
List types of Perceptual Trainning
S: Syntehic Speech Peception
A: Analytic Speech Perception Trainning
A: Active Filter Hypothesis trainning
T: TAP - Transfer Appropriate Processing
M: Meaning Based Orientaion Training
SAAT M
What is Speech Perception Trainning?
A structred apporoach to improving auditory processing skills
* Focuses on enhancing the ability to perceive & understand speech espcialy in challenging listning evniroment.
Why is Speech Perception Trainning Important?
- Improve Speech Understaning, especially for PHL
- Enhance listening skills in noise
- Improve Auditory Attention
List Core Training Components of speech perception trainning.
Auditory Discrimination
Auditory Closure
Auditory Memory
Auditory Attention
List Core Training Components of speech perception trainning.
Auditory Discrimination
- Training the ability to distinguish between similar sounds
Auditory Discrimination activities
Minimal Pair drills, sound discrimination exercises
List Core Training Components of speech perception trainning.
Auditory Closure
Training the ability to fill in missing speech sounds
Auditory Closure Activties
Word & Sentence Completion tasks, listening to degraded speech
List Core Training Components of speech perception trainning.
Auditory Memory
Training the ability to retain and recall auditory information
Auditory Memory Activities
Digits span tasks, Sentence repetition tasks
List Core Training Components of speech perception trainning.
Auditory Attention
Trainning the ability to focus on relevent auditory informtion & ignore background noise
Auditory Attention Activties
Dichotic Listening Tasks, listening in noise exercises.
Define Synthetic speech Training
Uses top - down processing to take in & analyze information
Define Analytic Speech Training
Uses Bottom - up processing to improve recognition of phonemic speech elements
Define Active Filter Hypothesis Training
Recognizes emotional factors block effectiveness of listning skills
* Emotions affect listening ability
Define TAP
Transfer Appropriate Processing
* Training Tasks that match the PHL desired outcomes more effective
* Using CP’s Voice & Common language used
Define Meaning Based Orientation Training
Use trainning materials that activate the language processing centers just like real world communcation
Describe the research findings related to cross modal reorganiztion
- Following clinical treatment with hearing aids, a reversal in cross-modal re-organization of auditory cortex by vision was observed in the ARHL group, coinciding with gains in speech perception and cognitive performance.
Following clinical treatment with hearing aids a ____ in _____ ______ of the auditory cortex by vision was observed in the ______ group coinsiding with gains in _____ & __________
Following Clinical treatment with hearing aids a reversal in cross - modal reorganization of auditory cortex by vision was observed in the Age related HL group coinciding with gains in speech perception and cognitve performace
Short version
Describe the research findings related to cross modal reorganization
- HA treatement study = reversal in Cross modal re-orgnizaion of auditory cortex
- improvment in speech perception & cogntive performance
Clincial Implication of research findings related to cross modal reorganization
- beyond usual benefits of HA’s the study = evidence that Clinical intervention may promote typical cortical organization & functioning = cognitive benefit
- Well Fit Amp needed ( verified fitting required)
Clinical impications of findings related to cross modal reorganization
Beyond the known benefits of hearing aid use on communcation outcomes the study reveled that clinical intervention with well - fit amplification may promote more typical cortical organization & Functioning & provide cognitive beneift.
Describe the research findings that show neural plasticity remains present throughout our lifetime. It even exists in the elderly population
Piano Study
Outcome:
* Faster Processing Speed
* Improved Memory
* Control Group Showed no changes
Just list categories
Which populations tend to maintain advanced brainstem encoding of auditory information skills as they age?
- Musical Trainning
- Tonal Langauge Speakers
- Bilingual Language Speakers
Details on categories
Which populations tend to maintain advanced brainstem encoding of auditory information skills as they age?
- Musical Training overlaps in brain networks that process speech & Music
- Tonal Language speakers show enhanced brainstem encoding
- Bilingual Language Speakers have greater brainstem encoding of the fundamental frequency
Only answer part 2
Which populations tend to maintain advanced brainstem encoding of auditory information skills as they age? How can this knowledge be used clinically?
When compared to age matched peers, older normal-hearing individuals in these populations have:
* Faster brainstem timing
* Greater representation of the harmonics of a speech syllable
* Superior cognitive skills which offset decline in working memory
Reccomend these thing to patients
how does the Musical training overlaps in anatomical brain networks that process speech and music?
- The precision in processing music is greater than for speech
- The emotion in performing music induces plasticity
- The attention necessary to produce music improves focus on details
why is this statement true? Even in the absence of hearing loss older adults require an extra +3-5 dB SNR when communicating in noise!
- Partly due to auditory mismatch resulting from age realted HL
- Reduction in cognitive processing abilities
- Higher SNR’s reduce cognitive load
True or False
Even in the absence of hearing loss older adults require an extra +5-7 dB SNR when communicating in noise!
FALSE
why is this statement true? Even in the absence of hearing loss older adults require an extra +3-5 dB SNR when communicating in noise!
Define mild cognitive impairment
- a condition that causes memory and thinking problems that are more severe than normal for a person’s age
- noticeable cognitive decline that is greater than expected for a person’s age but not severe enough to interfere significantly with daily life or independent functioning.
Define Crystallized Intelligence
- Ability to use skills
- Experiential Knowledge
- Does not decline
Define Fluid Intelligence
- Think Logically
- Solve Problems in novel situations
- declines in people
Define Perceptual Training
- A structured approach to improving auditory processing skills
- Focuses on enhancing the ability to perceive and understand speech, especially in challenging listening environments
Define Auditory Mismatch
Degraded input dosent match long term memory of signal
Suprasegmental
- Loudness Variations (intenisty, stress, patterns)
- Pitch Variation (intonation)
- Duration Varitaions (length of segment)
Pattern Recognition
Synthesized auditory memories are compared to stored patterns in your long term memory
synthesized auditory memory
Where the replica of the acoustic stimulus is stored for 250 msecs
echoic memory
creates the perfect replica of the acoustic stimulus
Think echo, copies
Why are slow-acting AGC-i compression settings easier to process for patients with poor working memory and cognitive decline?
Becuase slow acting AGC-i
* does not alter the speech envelope,
* Indiviudals w/ low working memory perform better
* prevents auditory mismatch
Define auditory mismatch and explain how it relates to speech intelligibility
Auditory Mismatch: The auditory message arriving to the brain is degarded by the auditory system & no longer matches its auditory memory
Mismatch in complex listening enviorments =
* degraded input doesnt match auditory memory
* Working memory processing declines
* Cochlear damage = further mismatch of incoming signals
* Distorted amplified signal or Unamplified signal does not match phonological representaion in long term memory
Which cognitive screening tools identify MCI?
- (MoCA) - Montreal Cognitive Assessment
- (SLUMS) - St.Louis University Mental State
What in fluid intelligence declines?
- General Sequential reasoning
- Working Memory
- Processing Speed
- Inhibitory Control
Cognitions impact on communcation
- as we age allocation of attention & Focus declines making it difficult to block irrelevant information and ignore competing noise
As we age Capcity reduces - load is not managed as efficiently in complex enviorments
- Capacity reduction requires more time to process signals
- Additional processing time = fatigue
Explain the meaning of this statement “Hearing loss is considered the most important modifiable risk factor for dementia”
- Hearing loss is associated with accelerated cognitive decline
- HL lead to social isolation & lonelieness
- HL shifts the cognitive load of the brain
- HL accelerates brain atrophy
What life experiences preserve an older adult’s ability to understand speech in noise?
Echoic Memory
* Creates replica of acoustic stimulus
* Briefly store for 250 msec - Synthesied auditory memory
Pattern Recognition
* Syntheised auditory memoriues are comapred to stored memories
Must be able to store info for 2 secs in short term while you retirve long term
How quickly you process the information will depend on
- Familiarity
- How Frequently your exposed to sound
- The emotional imortance of the sound
What impacts Processing Speed?
A: Allocation of Attention
S: Suprasegmental Information
C: Complexity of Task
C: Capacity & Load
Suprasegmental information
Superimposed on acoustic stimuli improving listener accuracy (right hemisphere) and helping the listener separate competing voices
Allocation of Attention
Allows us to selectively focus on a limited amount of information
- ignore competing noise
Complexity of task
more mental effort is needed to understand complex sentences
Capacity & Load
capacity is the total reservoir of energy available to spend on a task
Load: The total amount of energy that must be spent
when load is greater than capacity - fatigue
Conversational Principles
CASE
- Ease of understanding
- Active Participation
- Communcation Strategies
- Social & Emotional Factors
