midterm 1 Flashcards
apgar
evaluation that all newborns receive shortly after birth to detect obvious abnormalities
-used to identify if the baby is in distress
-based on heart rate, respiratory effort, reflex irritability, muscle tone and color
gestational age
defined in weeks as the duration of pregnancy before birth
-typically around 38-40 weeks
chronological age
age from actual day the child was born
prenatal
before birth
postnatal
after birth
perinatal
period around the time of birth
-from the 28th week of gestation through the 7th day following delivery
correlated/adjusted age
the actual age of the baby in weeks minus the number of weeks the baby was preterm
(CA = chronological age - # of weeks premature)
brief overview of the development of the ear
ear begins to develop around the 3rd week of life, external and middle ear are formed by branchial arches during 4th week and become recognizable by the 8th week and then structures of the inner ear mature around 20-26 weeks
when does the cochlea begin to function
24-26 weeks
-the auditory nerve is hooked up
how has evidence been found in utero to asses the auditory exposure in full term newborns
confirmed through using pure tones presented through a microphone placed on the mothers abdomen, heart rate increased in response to the tones that are recorded after the 20th week
what process do newborns go through after birth in regards to their hearing development
neural maturation
what are the red flags that indicate potential issues in speech and auditory development
no babbling or gesturing by 12 months, no single words by 16 months, no 2 word combinations by 24 months, no 3 word combinations by 3 years, unintelligible speech at 3, limited number of consonants at 2 years, simplified grammar at 3.5 years, difficulty formulating ideas and using vocab at 4 years and language not used communicatively
why do newborns have a preference to infant directed speech
they are attracted to the exaggerated intonation pattern
impact of mild HL on communication, language and social
perception of speech : vowel sounds are heard, voiceless are missed, louder sounds are hear but short unstressed/less intense sounds are missed
educational/behavioral : HL is not consistent so appears as inattention or behavioral problems
impact of moderate HL on communication, language and social
speech perception : vowels are heard better but conversation speech sounds are missed
communication confusion : trouble distinguishing speech sounds
speech articulation : omission/distortion so strangers may not understand
behavioral : inattention, language delay, speech problems and learning problems
impact of severe HL on communication, language and social
speech and language development delayed, distortion with sounds or self vocalization, most intense sounds at close range and significant language problems with associated educational problems
impact of profound HL on communication, language and social
severe language delays, speech problems, learning dysfunction, cannot hear or understand sounds without amplification, speech often includes issues with voice, articulation, resonance and prosody
how can HL impact academic achievement
the more HL, the more impacts there will be
-difficulty in all areas, but math and reading in particular
-mild to moderate HL achieve on average 1-4 grade levels lower than their peers
-severe to profound HL achieve skills no higher than third to fourth grade levels
-this gap widens as they progress through school
how can HL impact social interactions
-children with severe to profound HL report feeling isolated, without friends and unhappy in school
-social problems will be more frequency in children with a mild to moderate HL than those with severe to profound loses
what are some challenges in identifying minimal HL in newborns
current OAEs and ABRs do not distinguish between normal and mild HL
-minimal is anywhere within 15-25 dB
-testing has pass fail criteria that is often insufficient to determine validity with minimal or mild HL
how can a minimal HL impact a child
-50% of children repeat a grade or need resource support
-parents may not always understand the need for amplification
-missing some speech sounds, delayed speech
what are some key differences in case history b/w pediatric and adults
birth complications and developmental milestones
-prenatal and birth history, growth and physical development, educational progress, speech and hearing milestones
importance of a thorough case history
allows us to understand the patient and family and gives an observational opportunity
-gives us more information
why is it not ideal to ask a child for testing permission
they may become more resistant of treatment or testing
-try to get them to trust you and get on their level and tell them what will happen
how can a clinician determine the cognitive age of a child
case history, speech and language or psychoeducational evaluations
what is the importance of including behavioral assessment in hearing evaluations
allows for cross-check physiologic result with behavioral data by using a battery of tests to determine hearing sensitivity
-allows parents to participate in testing by allowing them to observe the infant
-can be used to monitor performance with technology
what to know about responses with behavioral testing
responses should be seen within 2 seconds of presentation
-ensure to count the same things as a response throughout the testing, do not change what you are marking as a response
headphones vs. soundfield
-sound field yields more responses than inserts do
-using earphones first may upset the child
-infant responses are better for localization in sound field than lateralization under earphones
challenges with wearing headphones in children
might not accept wearing them, may no longer want to stay within the booth and they may need to reschedule if no longer wanting to be tested
probe trial
supra threshold stimuli presented at a level at which the infant previously responded to
-used to demonstrate understanding of the task before descending in level
control trial
observation trials in which the examiner judges whether a head turn occurs in the absence of sound stimulation
-primarily used to determine if the responses head turn being judges are truly responses to the test stimuli and not just random head turns
behavioral observational audiometry (BOA)
measuring an infant’s awareness of sound, it doesn’t provide threshold information
-birth to 6 months, but can be used on older children with developmental delays or other disorders preventing body responses
what is the goal with BOA testing
to determine if the child has sufficient hearing to develop speech and language
how to position the child for BOA testing? what is the role of the parents?
needs to be resting in a comfortable position to support head and torso turn
-parents are to help make the baby comfortable
protocol for BOA
aim to gain both 2000 and 500 Hz, alternating sides in the soundfield
-ensure to get results that you are confident in
-typically ear specific may not be warranted
-depending on the child and how they are doing, you may be able to get additional frequencies but also you may not
CLINICAL REASONING: how do you determine which frequency to begin testing at
if there is a suspected SNHL begin at 500 Hz as high frequencies are the first to go however if there is a suspected CHL begin at 2000 Hz
-if there is no suspected HL, begin at 2000 Hz as children prefer these higher signals more
explain response patterns that occur with BOA
observations for eye widening, eye shifting, head orienting, arousal, limb movement and respiration changes
-some children will respond to the stimulus going on and others will respond to the stimulus going off
benefits of BOA
enables audiologist to obtain valuable behavioral responses in infants (part of cross check), can be conducted in sound fields/earphones/bone oscillator/HAs/CIs, and it enables accurate fitting of technology because minimal response levels can be obtained
limitations of BOA
requires careful observation of infant sucking by the audiologist, cannot be used with infants who do not suck, can be performed only when the infant is in a calm awake or light sleep state, and it is not generally accepted because they have not been trained to use a sucking response
what are some ways to maximize the sucking response in BOA
present stimuli at an appropriate pace, start from silence, watch the infant closely and loud sounds help identify response types and latencies with the aiding interpretation of softer sounds
visual reinforcement audiometry (VRA)
audiometric technique that involves training the infant to make a conditioned head turn in response to a stimulus
-5/6 months to 36 months
-child needs to be able to turn their head to identify the sound
what are the two conditioning phases used?
simultaneous stimulus-reinforcer pairing approach and response observation/shaping approach
what type of stimulus is used for VRA
-warble or NBN (frequency specific information)
-speech, noise or music (non-frequency specific)
protocol for VRA
testing can happen after conditioning has occurred
-starting level at 30 dB and if no response turn up 20 dB
-remember, we may get a limited amount of responses so limit the presentations at each level
-begin at 2000 Hz and then continue down to a lower frequency
-begin with soundfield!!
benefits of VRA
enables valuable behavioral responses in infants/young children, cross check principle, more responses possible per test session because they are conditioned, can be conducted in sound field/ear phones/HAs/CIs, enables accurate fitting of technology and the child is more involved in the task so the state if the infant/child is less problematic
limitations of VRA
obtaining individual ear data when child will not accept earphones
reasons to use two reinforces in VRA
it is not dependent on localization, so by having two it can allow the child to still react to the stimulus
-we will still reward if they turn to the speaker opposite of where the sound played
CLINICAL REASONING: what to do if there is a response to the combined stim/reward but not response to the stim alone
assess the stimulus to ensure it is audible/engaging enough, can increase it or change the type/frequency, and can use a vibrotactile stimuli from bone vibrator
CLINICAL REASONING: what to do if there is no response to the stim/reward combo
enhance the reward and it is possible that the child is not developmentally ready so adjust to a different test
conditioned play audiometry (CPA)
method of testing hearing in toddlers and preschoolers through conditioned motor response to sound using game activities
-ages 30 months to 5 years
what type of stimulus is used for CPA
warble tone or NBN (in order to gain frequency specific results)
-recommended to start with speech
protocol for CPA
begin with whatever transducer will require least amount of cooperation and begin at level that is audible (start around 40 if engaging in conversation)
-begin at 2000 Hz in one ear then 2000 Hz in the other and repeat at 500 Hz then determine additional frequencies to test
CLINICAL REASONING: how to determine which additional frequencies to test
using thresholds gained you can determine, for example if you have 30 at 500 and 70 at 2000 if would be beneficial to test 1000 Hz
CLINICAL REASONING: what is a good example of what a child could do when they hear the tone during CPA and why
the child could hold the toy near their ear as a response as this shows a deliberate movement and reaction and it is not something that occurs all the time
responses with CPA
make sure they are targeted responses that were intended to occur, should be deliberate and should occur within 3 to 4 seconds after the stimulus
benefits of CPA
accurate responses possible at threshold and can be conducted in soundfield or with earphone/bone/HAs/CIs
limitations of CPA
keeping the child entertained and involved long enough to obtain all the necessary information
what are the three types of responders
false responders, reluctant responders and off responders
false responders
wanting to play the game no matter if there is a sound or not
-can place an open hand in front of or resting against the child’s hand holding the responding peg or block
-child then has to go around the hand to complete the task once the sound is heard
reluctant responders
will wait until they are visually prompted to complete the task despite numerous training trials and reinforcement
-can encourage them to do the game when they look at you
off responders
prefer to wait until the stimulus has stopped prior to completing the task
-can use a continuous tone which can assist them in feeling more confident in responding because there is a definite off to the signal
CLINICAL REASONING: explain how the training/testing process is varied with a child that has severe to profound HL
they will take longer to condition
-the probe from inserts can be attached directly to earmolds
-can use a bone vibrator held in the hand or knee or on mastoid and then once there is consistent response begin with earphones
why is speech audiometry important within testing children
it helps determine how well the child uses hearing for communicative function
-underpins language development, academic success, social interactions, cognitive skills and emotional well being
how do you select a speech test
it is based on the child’s language abilities
-want to match cognitive, motor and attentional capabilities of the child
what are some challenges with speech audiometry
language/vocabulary of the kid, cognitive capabilities, attentional capabilities and articulation problems (causes for difficulty scoring)
speech awareness or speech detection thresholds (SDT)
lowest level to detect stimulus 50% of the time
-used for kids who are young, cognitively delayed or have limited vocabularies
-using child’s name, nonsense words or short phrases
-observe for eye widening, head turn or facial changes
why is SDT better than the PTA average?
children attend to speech and intonation so they are more likely to attend to it
speech recognition thresholds (SRT)
lowest level to identify speech stimuli 50% of the time
-social reinforcement should be provided throughout the session
-adapted based on age groups
-CRISP, CRISP-Jr, or bone conduction SRT
how do the tasks vary based on age group for SRT
young children : picture pointing or body parts, pick toys or follow simple verbal instructions
older children : ask them to repeat using standard tests, spondee words
ling 6 sounds
can be used to gain frequency specific information
-comparable to pure tone thresholds
speech discrimination tests
designed to evaluate a child’s ability to understand speech under different listening conditions
-performed at supra threshold levels
-various factors to consider
what level do we present at for speech discrimination thresholds
30 dB above SRT for normal hearing, 40 dB above SRT for HL
closed vs. open set
limited number of items and good for younger children vs. no clues, can be anything, good for older children
phoneme scoring
counting phonemes that were repeated correctly
-vowel errors correlated with insufficient low frequency
-sibilant errors correlated with insufficient high frequency
whole word scoring
scoring based on the full word being correct
-even with only one phoneme is wrong, the whole word is wrong
recorded stimulus
more reliable and comparable test-retest BUT is time consuming and more challenging for the child
-good for older kids
MLV stimulus
should be used when recorded testing is not avaliable or not possible to perform
-good for younger children as they attend to live voice more
full list vs. half list
reduces chance of scoring errors and increases reliability with the full list vs. use only if word list is validated to be used with fewer
NU-CHIPS
closed set picture pointing, scored as a percentage
-ages 3 to 5
WIPI
consists of picture plates containing 6 images with 4 rhyming
-ages 5 to 8
PBK-50
open set, scored as a percentage and required a verbal response
-ages 5 to 8
BKB-SIN
speech in noise test that uses sentences that are recorded in four talker babble on the same channel of the CD
-ages 5+
