final Flashcards
lipreading
watching the lip movements to extract speech information
-relying on visual cues from lip movements
speechreading
utilizes visual, auditory, gestural and contextual cues to understand speech
where are phonemic cues gathered from
mouth and lip movements
where are prosodic cues/judgements gathered from
eye areas
what sounds are easier to see
those that are created to the front of the mouth
-/f,v/ is easier whereas /k,g/ are harder since they are further back
visemes
sounds that look identical when produced
homophones
words that look identical on the mouth when produced
coarticulation
visible elements will appear different depending on the surrounding sounds
-impacts lipreading by how surrounding sounds impact the current sound both by visual cues and auditory cues
what are some cognitive skills that may predict lip reading abilities
working memory, visual word decoding, lexical identification speed, phonological processing, verbal interference, onset of HL
lexical neighborhood activation model (NAM) of integration
a model that deals with how our brain integrates information of speech into separate groups based on spoken words and visual representation of words automatically
dense neighborhoods
word groups which contain many words that sound and/or look the same
-processing speed slows down
sparse neighborhoods
word groups which contain few words that sound and/or look the same
-processing speech is faster
what helps shift a dense neighborhood to a sparse neighborhood
audio visual integration
-by using what we saw and what we heard, we are able to integrate that to a smaller subset of potential words based on the context
factors that can enhance audiovisual integration
residual hearing, grammatical structure, word familiarity/context, viewing angle/distance and how well you are feeling
what factors can negatively impact speech reading abilities
mumbles, not looking at you, chewing, accents, smiles too much, no facial expressions, shouts, high pitched voices, talking too fast, wearing dark glasses and complicated sentences
4 primary sources of communication breakdowns
listeners speech recognition skills, speakers delivery of the message, environment and message complexity
three stages of communication repair
detect the breakdown (requiring attention and active listening), choosing a course of action and taking course of action
maladaptive repair strategies
coping behaviors that provide short term benefits with long term consequences
-can look like dominating the conversation, ignoring the CP, bluffing, overreacting to miscommunication and withdrawal from social interactions
facilitative repair strategies
an attempt to identify and avoid communication breakdowns from occurring
-including both nonspecific and specific strategies
nonspecific strategies
not adding specific information in for what you did not understand or what you missed
-can be simply saying ‘what’ or ‘huh’
-leading to simple repetition of phrase
specific strategies
giving specific information regarding what was missed exactly, both conversation and supportive repair strategies
instructional strategies
listener instructs the speaker on a specific way to change the delivery of the message
-explanation, specific direction and positive reinforcement
message tailoring strategies
listener asks close ended questions to limit potential answers and amount of reputation required by the speaker
constructive strategies
actions are taken to change an environment for improved communication
-lighting, visual, angles, distance, reverberation, noise and visual distractions
anticipatory strategies
when the PHL prepares for conversational interactions in advance by anticipating conversational content and potential listening environments
adaptive strategies
methods to counteract maladaptive behaviors (emotions) that stem from HL
-can use relaxation techniques or grounding techniques
how does dual sensory loss impact the PHL
leads to the individual missing out on visual cues and will be more impacted by their HL due to the dual sensory loss
explain how reduced frequency resolution, temporal resolution and spatial processing impacts communication in noise
frequency resolution (reduced neural curves leading to sounds do not pop out of the noise), reduced dynamic range, noise that has a masking effect, age related changes (not able to attend to the signal of speech when around noise), temporal resolution (when hard to hear gaps, then the words tend to blend together)
third party disability
a disability of family members due to the health condition of their significant other
-describes a range of activity limitations and participation restrictions experienced by the CP
what are some ways that HL can impact the CP
stress of lifestyle changes, communication difficulties, anxiety, frustration, social isolation, decreased quality of life
what is an example of a questionnaire designed to provide insight into the CPs needs
hearing impairment impact-significant other profile (HII-SOP)
steps involved in partner goal setting activities
PHL/CP identify key listening situation that both parties want to improve, audiologist uses open ended questions to let each party reflect on their experiences while considering the other point of view, after exploring problems with each party the audiologist has the two discuss problems they experience together, create a list of achievable goals for each problem, brainstorm ideas/tactics to achieve each goal
list of HL facts to explain to the CP
possible to hear voices but to still have difficulties understanding some words, HL can cause people to be sensitive to loud sounds, trying to understand all day takes effort and is exhausting
how can a CP help the listener
get the PHL’s attention before talking, move closer to the PHL/face them, use facial expression with gestures, inform the listener when the subject changes, do not speak while chewing and stay patient and positive
research associated with clear speech and the benefits that have been found
a 45 minute intervention training session yielded changes in more speech parameters, more stable changes and better speech recognition
-improving intelligibility for both normal and hearing impaired individuals
steps for clear speech training
review communication breakdowns/introduce clear speech, create activities to practice clear speech, practice clear speech using structured conversations and practice in the real world
how can the CP advocate for the communication needs of the PHL
let people know how speaking slower and only slightly louder is helpful, remind a group that only one person should speak at a time, sit next to them, share the topic of conversation when they join
assertive communication strategies
telling people your needs or ideas clearly and directly
-not being afraid or shy when explaining what you need
-using “i statements”
-be an eagle and not a turtle
non-assertive/passive communication strategies
avoids situations in which they fear they will not be able to communicate well in because they avoid speaking up when they cannot hear something
-tend to bluff
-has a difficulty identifying their communication needs
indications of relying on non-assertive strategies when ….
does not stand up for what is best for you, does not let others know what you need/want or letting others decide what is best for you
results of using non-assertiveness
increased anxiety, judged by appropriate responses, dependence due to increased reliance on CP and feelings of helplessness
_______________ is referred to as maladaptive
non-assertive/passive
repetitive usage of these maladaptive strategies can lead to responses such as ….
anger, fear, disgust, sadness, anxiety, depression, shame and envy
aggressive communication strategies
believing that your needs are more important than others
-dominating conversations, blaming others for breakdowns, dismissive, defensive
results of using aggressive strategies
perceived as trampling, CPs may feel hurt, viewed as a bully, alienates friends/family
-this rarely will solve any long term communication problems
passive aggressive communication strategies
believing that your goals come first but not able to express that
-using sarcasm, withholds responses until needs are met, exhibits stubbornness
advantages of group AR programs over individual sessions
group programs create an atmosphere of peer support with participants that learn from each other, groups become a place for practicing communication skills, group sessions provide a space for people to share/learn from on another’s and group sessions are time and financially efficient
patient benefits from AR
reduced activity limitations/participation restrictions, attainment of communication goals, speechreading benefits were better understood, those who participated employed communication strategies better than those who did not and improved emotional well being
CP benefits of AR
reduces third party disability and improved quality of life
financial benefits of AR
results in fewer returns of HAs and results in less office visits therefore creating a more cost effective treatment
practice benefits of AR
improved daily rating of HA satisfaction, fewer HA returns, increased patient satisfaction
learning preferences of adults
motivated/self directed, bring life experiences to learning expectations, goal oriented, wanting to be sure what they are learning is relevant to their goals, they are practical, they want to feel respected
validation measures
the process of assessing the effectiveness of audiological intervention
-demonstrates value of audiological services, improves clinical practice and justifies reimbursement for services
goal of validation
ensures that the measured output is as close as possible to those prescribed for the patient
in terms of healthcare analytics, what is the importance for validation
-provides data to insurers, HMOs, state and federal government entities
-documents audiology services effectively reducing restriction
-shows patients and families that intervention was beneficial
-validates a clinical decision
-data may be used to support marketing services
who are stakeholders
regulatory bodies, health insurance industry and consumers
4 categories of validation
assessment of treatment usage/adherence, measurement of objective aided performance, self report measurement of subjective benefit and self reported measurement of subjective satisfaction
evaluation criteria for SII verification
if aided SII falls within the 95% criteria lines, the clients fitting is electro acoustically acceptable
root mean squared error (RMSE)
the difference between the probe measures output and the prescriptive targets (500, 1k, 2k and 4k)
-typically used for pediatrics
evaluation criteria for RMSE verification
if falls within 5dB or less, that is a strong indication that the fitting is accurate
when is it appropriate to complete validation measures
within 4-6 weeks after fitting
-however, this can be adjusted based on how the patient is doing in terms of adapting to their new technology or new AR plan
validation with usage
reviewing datalogging to determine patterns of daily usage
-can use any aspects to counsel and talk with the patient regarding their experience with the technology
aspects to look at in terms of usage
does it match recommendations, does patient reset start up volume, look at environmental variations, manual programs, address any unexpected deviations
validation with objective test methods
conducting aided speech assessments within the sound field
-presenting at 50-60dB A typically
-measuring both in quiet and in noise
-comparing results to unaided performance for each condition
checklist to ensure when validating objective test methods
confirm improved audibility, confirm SNR loss did not degrade with omnidirectional, confirm SNR loss improved with directional, confirm improved speech understanding with FL, confirm audio visual integration benefit and discuss any residual performance limitations in noise
validation with subjective benefit assessment
identifies improvement of activity limitations and participation restrictions
-allow for both pre and post fit measurements
-can include the COSI (allowing to assess the degree of improvement for each individuals goal)
validation with subjective satisfaction assessments
allowing to see how the patient is satisfied within their AR and with their technology
