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AUDE 6240 > final exam comprehensive > Flashcards

final exam comprehensive Flashcards

1
Q

lax diagnostic criteria

A

if they fail one test, they have it
-better sensitivity but poor specificity

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2
Q

intermediate criteria

A

abnormal performance on at least 2 tests or on at least 1 test
-we utilize the standard deviations

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3
Q

strict criteria

A

all tests are failed to have the diagnosis
-better specificity but poor sensitivity

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4
Q

(C)APD

A

a complex, heterogenous, bottom up perceptual disorder affecting the auditory system ; a sensory processing deficit that impacts listening, spoken language, comprehension and learning

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5
Q

developmental APD

A

cases presenting in childhood with normal hearing and no other known etiology or potential risk factors

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6
Q

acquired APD

A

cases associated with a know post natal event that could plausibly explain the APD

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7
Q

secondary APD

A

cases where APD occurs in the presence or as a result of peripheral hearing impairment

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8
Q

what is the testing criteria for CAPD

A

age : 7 years or olde r
hearing : WNL 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

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9
Q

4 subtypes of (C)APD

A

lexical decoding, tolerance fading memory (TFM), organizational deficits and integration deficits

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10
Q

lexical decoding deficits

A

difficulties in processing the words of a language, verbal and written
-most common
-results in poor reading, spelling and word finding abilities
-left posterior temporal lobe is involved

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11
Q

tolerance fading memory (TFM)

A

difficulty listening in noise and recalling information presented earlier
-weak expressive language and poor handwriting
-frontal and anterior temporal lobe with a small region of the parietal lobe are involved

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12
Q

organizational deficits or output organizational deficit

A

significant corrupted auditory sequencing or planning
-displays difficulty with sequential information
-child is disorganized at home and in school
-pre and post central gyri with anterior temporal lobe are involved

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13
Q

integration deficit

A

decreased ability to integrate acoustic and linguistic information across difference processing modalities
-difficulty with integrating suprasegmental and linguistic information
-corpus callosum is involved

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14
Q

what are the four main auditory processes that are assed by (C)APD tests

A

dichotic processes, temporal processes, binaural interaction and low redundancy speech/auditory closure processes

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15
Q

if someone has dichotic processing deficits, what could they present with

A

speech in noise issues, difficulty in complex environments, difficulty with rapid speech and difficulty following directions

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16
Q

if someone has deficits with temporal processing, what could they present with

A

difficulty with timing cues, difficulty understanding fast speech, difficulty following rhythms and patterns
-leading to difficulty reading and writing

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17
Q

if someone has binaural interaction deficits, what could they present with

A

difficulty localizing, difficulty in noise and spatial awareness issues

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18
Q

if someone has auditory closure processing deficits, what could they present with

A

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

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19
Q

examples of tests that assess dichotic processes

A

dichotic digits, competing sentences, SSI-CCM and SSW

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20
Q

examples of tests that assess temporal processes

A

GIN, RGDT, DPT and PPST

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21
Q

examples of tests that assess binaural interaction

A

auditory fusion and MLD

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22
Q

examples of tests that assess low redundancy speech/auditory closure processes

A

filtered words, TCS, SSI-ICM and speech in noise tests

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23
Q

what are the MLD recorded norms? MLD short version norms?

A

14 dB or greater ; 10 dB or greater

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24
Q

what is the GIN score norm? gap threshold norm?

A

52% (8-11) and 54% (12+) ; below 8 ms (anything greater than or equal to 8 is of concern)

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25
Q

what is the RGDT norm?

A

below 20 ms (anything equal to or greater than 20 ms is of concern)

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26
Q

what is a pattern that can help with a definitive diagnosis of (C)APD

A

unilateral deficit result, this indicates that they understood the task in the other ear so that this outcome was not due to linguistic, cognitive or attention disorders
-we can be confident that it is (C)APD if seeing a unilateral deficit, especially a left ear deficit

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27
Q

504 plan

A

falls under section 504 of the rehabilitation act of ADA
-spells out accommodations needed for students to have an opportunity to perform at the same level as their peers
-can be educational accommodations or just general accommodations to help the child be successful

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28
Q

IEP

A

falls under the individuals with disabilities act (IDEA) and is federally mandated in providing education services
-providing educational services to those who need it

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29
Q

what type of plan can a child get with a diagnosis of (C)APD

A

504 plan

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30
Q

bottom up processing (data driven)

A

information processing that is guided by input
-most sensory information such as sound is a example
-senses allow us to interpret the scene around us

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31
Q

top down (conceptually driven)

A

information processing that is guided by higher level cognitive processes that draw on experiences and expectations to contract perceptions
-occurs any time a higher level concept influences interpretation of lower level sensory data

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32
Q

why is (C)APD controversial

A

lack of gold standard, sensitivity/specificity, no standardized test battery or standard for diagnostic criteria and poor test performance is not consistent with real life performance influence of language/attention/cognition

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33
Q

ADHD

A

neurobehavioral childhood disorder that primarily affects children and often continues into adulthood that is characterized by inattention or hyperactivity-impulsivity

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34
Q

what are the two criterion to diagnose ADHD

A

A1/inattention, A2/hyperactivity or a combination of A1 and A2

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35
Q

criterion A1, inattention symptoms

A

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

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36
Q

criterion A2, hyperactivity symptoms

A

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

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37
Q

combination of A1 and A2

A

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)

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38
Q

how is ADHD diagnosed in accordance of DSM-5

A

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

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39
Q

differential diagnosis ADHD and (C)APD

A

ADHD: top down global disorder
(C)APD: bottom up primarily auditory perceptual disorder
-can differentiate with the digit span test in auditory and visual modalities, if does not do well in visual then would be looking more at ADHD

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40
Q

differential diagnosis language and (C)APD

A

auditory processing begins to transition from acoustic to a linguistic phenomenon, resulting in impaired language comprehension

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41
Q

developmental language disorder (DLD)

A

disorder that delays the mastery of language skills in children who have no HL or other developmental delays (previously known as specific language impairment)

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42
Q

differential diagnosis DLD and (C)APD

A

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
-they found no differences between the two groups of children
-concluded that children were diagnosed based on their referral route vs. actual differences

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43
Q

dyslexia

A

learning disorder that primarily affects reading and writing skills, it does not impact intelligence levels

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44
Q

differential diagnosis dyslexia and (C)APD

A

calcus et. al investigated the relationship between categorial perception and psychometric function of speech identification in noise of children with dyslexia
-they concluded that inconsistencies in poor performance in the SIN perception tasks and across SIN, CP and reading in children with dyslexia and the absence of a relationship indicates that there may be something else going on

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45
Q

role of audiologist with management of (C)APD

A

evaluation and/or interpretation of test results for educational relevance
-communicate with members of the team
-monitor classroom environment
-recommend and manage FM systems
-auditory training

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46
Q

bottom up (environmental) strategies

A

auditory training, enhanced signal audibility such as FM/remote microphone, environmental modification

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47
Q

top down (metacognitive) strategies

A

language strategies, cognitive strategies, metacognitive strategies and classroom instructional/learning strategies

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48
Q

what are the 4 main categories for managing (C)APD

A

auditory environment, auditory training, music training and training with phonemes/words

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49
Q

what is the role with managing the auditory environment

A

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

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50
Q

what can be done in order to manage the auditory environment

A

hearing assistive devices, speaker changes, manage ambient noise levels, monitoring SNRs and reverberation time, using signal enhancement systems and HAs

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51
Q

examples of modifications that can be done to manage ambient noise levels

A

double paned windows, noise control devices on heating/cooling, lowering ceiling levels, carpeting, curtains, use of bookcases

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52
Q

what are the two main types of signal enhancement systems

A

individual FM systems (directly to the child’s ear) and digital sound distribution systems (throughout the classroom)

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53
Q

auditory training

A

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

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54
Q

auditory training : preschool intervention

A

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)

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55
Q

auditory training : school age intervention

A

goal is to focus on strategies and techniques that reduce communication and learning disabilities
-ex. figure ground training to apply listening in noise skills

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55
Q

auditory training : adult intervention

A

goal is to focus on compensation and relearning rather than recovery of function

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56
Q

music training

A

though 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

57
Q

music training has been shown beneficial for ……..

A

disorders such as autism, ADHD, language therapy for aphasia following a stroke

58
Q

training with phonemes and words

A

useful for children with poor phonemic decoding, spelling and reading skills such as fast for word and lindamood bell
-benefits occur over time

59
Q

computer based auditory training falls under auditory training however it is …….

A

adaptive
-meaning they need to gain the child’s attention

60
Q

with CBAT, what are some components we need to consider with the stimulus

A

-synthetic speech, natural non speech or synthetic non speech
-focused (active) attention or unfocused (passive attention)

61
Q

synthetic speech

A

allows for more accurate control of parameters such as duration and intensity

62
Q

natural non speech (environmental)

A

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

63
Q

synthetic non speech

A

including tones or noise burst and typically is the least interesting stimuli for listeners
-more precise training in discrete frequency, intensity and temporal domains

64
Q

focused (active) attention vs. unfocused (passive) attention

A

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

65
Q

what are some popular CBAT programs

A

Fast ForWard, Earobics, Lindamood Bell

66
Q

auditory neuropathy spectrum disorder (ANSD)

A

a disorder of auditory dssynchrony of the 8th nerve ; timing is impacted

67
Q

with ANSD, what testing is normal

A

OAEs and a recordable cochlear microphonic (CM)

68
Q

with ANSD, what testing is abnormal

A

ARTs, ABRs, ECochG and MLDs
-anything having to do with the 8th nerve will have an abnormal test

69
Q

cochlear microphonic (CM)

A

reverse polarity (rarefaction vs. condensation)
-may have longer than normal amplitude and can ring longer mimicking an ABR

70
Q

common risk factors for ANSD

A

family history, hyperbilirubinemia, infection or immune disorders

71
Q

hidden HL or cochlear syanptopathy

A

an acquired condition that permanently interrupts synaptic communication between sensory IHCs and afferent 8th nerve fibers well before HL is diagnosed
-seen with noise induced HL and aging

72
Q

with hidden HL, they will have normal thresholds but …..

A

will struggle with speech in noise

73
Q

differential diagnosis ANSD and (C)APD

A

they both have a lot of the same risk factors as well as there is not single cause. they are both peripheral disorders with central implications
-however ANSD is modality specific and it not secondary to cognitive, linguistic or related factors

74
Q

cerebrovascular accidents (CVAs)

A

the most common cause of cerebral damage
-aka strokes
-risk factors include high blood pressure, heart disease, diabetes, smoking, increasing age and a prior stroke

75
Q

two mechanisms of CVAs

A

ischemia (thrombus or embolus ; some blood clot) or hemorrhage (blood vessel ruptures)
-end result depends on the size of the blood vessel, the volume of brain tissue damages and anastomosis of the blood vessels

76
Q

with CVAs, what tests are consistent with peripheral hearing? what test are inconsistent with peripheral hearing?

A

consistent : tymps, reflexes, OAEs
inconsistent : WRS

77
Q

concussion

A

a diffuse, non penetrating TBI caused by a sudden external force
-brain can bounce around or twist in the skull, creating chemical changes in the brain

78
Q

who are most prone for concussions

A

athletes and military personnel/veterans

79
Q

4 categories of concussion symptoms

A

-cognitive impairments (i.e. difficulty concentrating or short term memory)
-physiological impairments (i.e. blurred vision or hearing problems)
-emotional problems (i.e. feelings of sadness or depression)
-sleep disturbances

80
Q

effects that concussion has on the auditory system

A

it can impair listening abilities and the ability of processing auditory information
-with a concussion there is axon damage, inflammation and bruising which can disrupt the temporal precision, leading to poor encoding of sound
-additionally, after a TBI the axons can degenerate

81
Q

concussions and PTSD

A

when a concussion is related to a blast exposure, there may be other injuries that can mask the concussion such as PTSD
-this can lead to sleep disturbances or anxiety
-when this occurs, it can make both the symptoms of the concussion worse as well as it can heighten the PTSD

82
Q

chronic traumatic encephalopathy (CTE)

A

a rare neurodegenerative injury that does not show symptoms until years after the repeated head injuries
-can lead to mood disorders, short term memory loss, depression, cognitive decline and dementia

83
Q

what causes CTE

A

accrual of concussive and sub concussive events over time
-believed to lead to progressive decline and dementia

84
Q

central deafness

A

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

85
Q

common site of lesion for central deafness

A

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

86
Q

what should be done in order to diagnose central deafness

A

a complete peripheral audiologic assessment, behavioral (C)APD tests, evoked potentials, MRI and CT scan
-pure tones, speech, immittance, OAEs

87
Q

in terms of an audiological assessment, what results are expected with central deafness

A

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

88
Q

depending on the etiology of central deafness, these patients may not be able to perform ……

A

(C)APD tests
-due to adverse effects on attention and memory

89
Q

in terms of evoked potentials woth central deafness, what could be expected

A

ABR is generally normal and mid to late responses may be abnormal dependent on the site and size of lesion

90
Q

with central deafness, what is the management dependent on

A

etiology

91
Q

what are some helpful management strategies for central deafness

A

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

92
Q

over time, patients with central deafness will ….

A

recover at least some auditory function

93
Q

differential diagnosis central deafness and NOHL

A

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

94
Q

differential diagnosis central deafness and (C)APD

A

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

95
Q

differential diagnosis central deafness and dementia

A

both have adult onset and sometimes people with dementia may appear with NOHL
-important to test cognition as well

96
Q

differential diagnosis central deafness and tumors

A

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

97
Q

what are the three risk factors for older adults with auditory processing skills

A

peripheral factors, cognitive factors and central auditory factors

98
Q

when we say peripheral factors, what are we discussing

A

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

99
Q

describe cross modal reorganization

A

a cortical compensation that is seen in deafness and HL when the auditory cortex is re-purposed by visual or somatosensory modalities

100
Q

with changes in tonotopic organization, what can this lead to

A

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

101
Q

hidden hearing loss

A

partial loss of auditory nerve fiber from noise induced synaptopathy resulting in reduced neural output from the cochlea
-impacts temporal coding, leading to difficulty understanding speech in noise

102
Q

when we say cognitive factors, what are we discussing

A

ease of language learning understanding (ELU) model, working memory and the resource allocation model

103
Q

ease of language understanding (ELU) model

A

a theoretical model that has been developed to describe the relationship between cognitive processes and speech understanding

104
Q

how does working memory play an important role in auditory processing

A

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

105
Q

resource allocation model

A

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

106
Q

when we say central auditory factors, what are we discussing

A

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
-loss of neurons impacts the ability of the area to funciton

107
Q

with central auditory factors, it is important to discuss the corpus callosum. what age related changes are seen

A

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)

108
Q

assessment of (C)APD in older adults

A

case history, hearing evaluation, tests for language and phonological processing, (C)APD behavioral tests, cognitive/psychological evaluation and physiologic tests

109
Q

with older adults, we can only conduct (C)APD assessments with age appropriate norms however why is this a concern

A

older adults are not homogenous so it becomes difficult to have norms for this age as everyone varies greatly already

110
Q

management of (C)APD in older adults

A

both bottom up and top down approaches, rhyming activites and proper counseling

111
Q

bottom up approaches for older adults

A

enhancing acoustic skills through amplification, improving SNR through FM or remote microphone, training specific auditory skills

112
Q

top down approaches for older adults

A

used to provide compensatory strategies to minimize the impact of (C)APD through strengthening of higher order central resources (language, attention and memory)

113
Q

why may older adults benefit from rhyming activities

A

may help regain some lost processing abilities

114
Q

importance of proper counseling

A

can provide realistic expectations and better acceptance

115
Q

clinical entity

A

denotes a concept of uniformity on patients
-ultimate reference for the entire field of medicine
-facilitates diagnostic and therapeutic approaches to individual patients

116
Q

according to vermiglio, what are the 5 criteria essential to be an entity

A

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

117
Q

ultimately, why does vermiglio say that (C)APD is not a clinical entity (using the 5 criteria)

A
  1. no, no agreed upon definition and it varies based on group
  2. no, everyone presents differently
  3. 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
  4. there is no gold standard in order to know if the results are accurate of (C)APD
  5. intervention is often deficit specific and since (C)APD has not gold standard there is no clear intervention
118
Q

academic profile of (C)APD

A

not working up to potential, doing poorly in schoolwork, weakness with spelling/reading/writing, strong math skills, difficulty following directions, better performance on non-auditory tasks

119
Q

non-academic profile of (C)APD

A

may appear hearing impaired but hearing sensitivity is normal, history of chronic or recurrent OME, poor sound localization, may inhibit behavioral problems

120
Q

sensation

A

ability to identify the presence of sound

121
Q

localization

A

determine the location of the signal

122
Q

auditory resolution or discrimination

A

ability to discriminate between sounds that differ in frequency, duration and intensity

123
Q

auditory attention

A

ability to attend to relevant acoustic signals

124
Q

auditory figure ground

A

ability to identify the primary sound source from background noise

125
Q

auditory closure

A

ability to fill in the missing parts of speech

126
Q

auditory analysis

A

ability to identify phonemes or morphemes embeded in words

127
Q

auditory synthesis

A

ability to merger or blend phonemes into words

128
Q

auditory association

A

ability to attach meanign

129
Q

auditory memory

A

recall of acoustic signal after it has been stored

130
Q

problems with auditory discrimination can result in ….

A

difficulty following directions, reading, spelling and writing

131
Q

auditory synthesis is critical to the __________ process

A

reading

132
Q

what are a few examples of disorders that need to be differentially diagnosed from CAPD

A

ADHD, language disorders, ASD, developmental delays, executive function deficits

133
Q

short term memory

A

temporary recall of the information which is being processed at any point in time

134
Q

long term memory

A

storage of information over a long period of time

135
Q

individuals with auditory closure deficits will perform poorly on ….

A

low pass filtered speech, speech in noise tests and time compressed speech

136
Q

what are important considerations when creating a test battery

A

sensitivity/specificity, test reliability, ease of administration and population characteristics

137
Q

what is the point of overlap between audition and language

A

phonemic awareness/processing

138
Q

by providing FM systems or HAs, this can decrease ….

A

cognitive load of the child

139
Q

central presbycusis

A

age related changes in the auditory portions of the CNS negatively impact auditory perception, speech communication performance or both
-as a conclusion, there is not enough information to state it as its own isolated entity

AUDE 6240 (3 decks)

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