final exam comprehensive Flashcards
lax diagnostic criteria
if they fail one test, they have it
-better sensitivity but poor specificity
intermediate criteria
abnormal performance on at least 2 tests or on at least 1 test
-we utilize the standard deviations
strict criteria
all tests are failed to have the diagnosis
-better specificity but poor sensitivity
(C)APD
a complex, heterogenous, bottom up perceptual disorder affecting the auditory system ; a sensory processing deficit that impacts listening, spoken language, comprehension and learning
developmental APD
cases presenting in childhood with normal hearing and no other known etiology or potential risk factors
acquired APD
cases associated with a know post natal event that could plausibly explain the APD
secondary APD
cases where APD occurs in the presence or as a result of peripheral hearing impairment
what is the testing criteria for CAPD
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
4 subtypes of (C)APD
lexical decoding, tolerance fading memory (TFM), organizational deficits and integration deficits
lexical decoding deficits
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
tolerance fading memory (TFM)
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
organizational deficits or output organizational deficit
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
integration deficit
decreased ability to integrate acoustic and linguistic information across difference processing modalities
-difficulty with integrating suprasegmental and linguistic information
-corpus callosum is involved
what are the four main auditory processes that are assed by (C)APD tests
dichotic processes, temporal processes, binaural interaction and low redundancy speech/auditory closure processes
if someone has dichotic processing deficits, what could they present with
speech in noise issues, difficulty in complex environments, difficulty with rapid speech and difficulty following directions
if someone has deficits with temporal processing, what could they present with
difficulty with timing cues, difficulty understanding fast speech, difficulty following rhythms and patterns
-leading to difficulty reading and writing
if someone has binaural interaction deficits, what could they present with
difficulty localizing, difficulty in noise and spatial awareness issues
if someone has auditory closure processing deficits, what could they present with
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
examples of tests that assess dichotic processes
dichotic digits, competing sentences, SSI-CCM and SSW
examples of tests that assess temporal processes
GIN, RGDT, DPT and PPST
examples of tests that assess binaural interaction
auditory fusion and MLD
examples of tests that assess low redundancy speech/auditory closure processes
filtered words, TCS, SSI-ICM and speech in noise tests
what are the MLD recorded norms? MLD short version norms?
14 dB or greater ; 10 dB or greater
what is the GIN score norm? gap threshold norm?
52% (8-11) and 54% (12+) ; below 8 ms (anything greater than or equal to 8 is of concern)
what is the RGDT norm?
below 20 ms (anything equal to or greater than 20 ms is of concern)
what is a pattern that can help with a definitive diagnosis of (C)APD
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
504 plan
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
IEP
falls under the individuals with disabilities act (IDEA) and is federally mandated in providing education services
-providing educational services to those who need it
what type of plan can a child get with a diagnosis of (C)APD
504 plan
bottom up processing (data driven)
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
top down (conceptually driven)
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
why is (C)APD controversial
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
ADHD
neurobehavioral childhood disorder that primarily affects children and often continues into adulthood that is characterized by inattention or hyperactivity-impulsivity
what are the two criterion to diagnose ADHD
A1/inattention, A2/hyperactivity or a combination of A1 and A2
criterion A1, 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
criterion A2, 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
combination of A1 and 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)
how is ADHD diagnosed in accordance of DSM-5
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
differential diagnosis ADHD and (C)APD
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
differential diagnosis language and (C)APD
auditory processing begins to transition from acoustic to a linguistic phenomenon, resulting in impaired language comprehension
developmental language disorder (DLD)
disorder that delays the mastery of language skills in children who have no HL or other developmental delays (previously known as specific language impairment)
differential diagnosis DLD and (C)APD
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
dyslexia
learning disorder that primarily affects reading and writing skills, it does not impact intelligence levels
differential diagnosis dyslexia and (C)APD
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
role of audiologist with management of (C)APD
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
bottom up (environmental) strategies
auditory training, enhanced signal audibility such as FM/remote microphone, environmental modification
top down (metacognitive) strategies
language strategies, cognitive strategies, metacognitive strategies and classroom instructional/learning strategies
what are the 4 main categories for managing (C)APD
auditory environment, auditory training, music training and training with phonemes/words
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
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
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 for word 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
auditory neuropathy spectrum disorder (ANSD)
a disorder of auditory dssynchrony of the 8th nerve ; timing is impacted
with ANSD, what testing is normal
OAEs and a recordable cochlear microphonic (CM)
with ANSD, what testing is abnormal
ARTs, ABRs, ECochG and MLDs
-anything having to do with the 8th nerve will have an abnormal test
cochlear microphonic (CM)
reverse polarity (rarefaction vs. condensation)
-may have longer than normal amplitude and can ring longer mimicking an ABR
common risk factors for ANSD
family history, hyperbilirubinemia, infection or immune disorders
hidden HL or cochlear syanptopathy
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
with hidden HL, they will have normal thresholds but …..
will struggle with speech in noise
differential diagnosis ANSD and (C)APD
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
cerebrovascular accidents (CVAs)
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
two mechanisms of CVAs
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
with CVAs, what tests are consistent with peripheral hearing? what test are inconsistent with peripheral hearing?
consistent : tymps, reflexes, OAEs
inconsistent : WRS
concussion
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
who are most prone for concussions
athletes and military personnel/veterans
4 categories of concussion symptoms
-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
effects that concussion has on the auditory system
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
concussions and PTSD
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
chronic traumatic encephalopathy (CTE)
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
what causes CTE
accrual of concussive and sub concussive events over time
-believed to lead to progressive decline and dementia
central deafness
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
common site of lesion for central deafness
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
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 woth 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 helpful 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
differential diagnosis central deafness and NOHL
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
differential diagnosis central deafness and (C)APD
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
differential diagnosis central deafness and dementia
both have adult onset and sometimes people with dementia may appear with NOHL
-important to test cognition as well
differential diagnosis central deafness and tumors
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
what are the three risk factors for older adults with auditory processing skills
peripheral factors, cognitive factors and central auditory factors
when we say peripheral factors, what are we discussing
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
describe 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
with changes in tonotopic organization, what can this 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
hidden hearing loss
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
when we say cognitive factors, what are we discussing
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
when we say central auditory factors, what are we discussing
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
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)
assessment of (C)APD in older adults
case history, hearing evaluation, tests for language and phonological processing, (C)APD behavioral tests, cognitive/psychological evaluation and physiologic tests
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
management of (C)APD in older adults
both bottom up and top down approaches, rhyming activites and proper counseling
bottom up approaches for older adults
enhancing acoustic skills through amplification, improving SNR through FM or remote microphone, training specific auditory skills
top down approaches for older adults
used to provide compensatory strategies to minimize the impact of (C)APD through strengthening of higher order central resources (language, attention and memory)
why may older adults benefit from rhyming activities
may help regain some lost processing abilities
importance of proper counseling
can provide realistic expectations and better acceptance
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
ultimately, why does vermiglio say that (C)APD is not a clinical entity (using the 5 criteria)
- 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
academic profile of (C)APD
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
non-academic profile of (C)APD
may appear hearing impaired but hearing sensitivity is normal, history of chronic or recurrent OME, poor sound localization, may inhibit behavioral problems
sensation
ability to identify the presence of sound
localization
determine the location of the signal
auditory resolution or discrimination
ability to discriminate between sounds that differ in frequency, duration and intensity
auditory attention
ability to attend to relevant acoustic signals
auditory figure ground
ability to identify the primary sound source from background noise
auditory closure
ability to fill in the missing parts of speech
auditory analysis
ability to identify phonemes or morphemes embeded in words
auditory synthesis
ability to merger or blend phonemes into words
auditory association
ability to attach meanign
auditory memory
recall of acoustic signal after it has been stored
problems with auditory discrimination can result in ….
difficulty following directions, reading, spelling and writing
auditory synthesis is critical to the __________ process
reading
what are a few examples of disorders that need to be differentially diagnosed from CAPD
ADHD, language disorders, ASD, developmental delays, executive function deficits
short term memory
temporary recall of the information which is being processed at any point in time
long term memory
storage of information over a long period of time
individuals with auditory closure deficits will perform poorly on ….
low pass filtered speech, speech in noise tests and time compressed speech
what are important considerations when creating a test battery
sensitivity/specificity, test reliability, ease of administration and population characteristics
what is the point of overlap between audition and language
phonemic awareness/processing
by providing FM systems or HAs, this can decrease ….
cognitive load of the child
central presbycusis
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
