Paediatric Speech Testing Flashcards
What is the purpose of speech testing?
Cross check audiogram
Alternative to VROA - broad idea of hearing ability
Compare performance under different conditions
Compare with norms
Differential diagnosis
Functional ability
Evaluate therapeutic, educational and/or rehabilitative procedures
High face validity
Difficult to malinger
Cons of speech testing
Time
Working with kids with speech delays, child may not participate
Could worry parents more than necessary if child doesn’t respond to VROA or speech
Factors to consider
Materials
Delivery
Response parameters
Speech material considerations
Redundancy
- CV - CNC - Monosyllables - Spondees - Sentences
Acoustic content
- e.g. male vs, female, although research doesn’t suggest this is too important
Phonetic Balance
- each list contain phonetic elements in approximately the same proportion that they occur in english - would need to have really long list - but this has also been found that it doesn't affect results
Word familiarity
- the more familiar the word the easier it is to recognise
Speech test response parameters
Open/Closed sets
- start speech testing at 2.5-3years all closed sets - can use pointing tests for some kids up to 8-9years old
Number of items per list
- a lot of paeds tests have around 10 or so items
Kendall toy test
Suitable for children 2.5years and up
Picture pointing task that is presented live voice (mouth covered) monitored by SLM
10 items, monosyllabic
Words would be in vocab of a normal hearing 2.5year old
Get toys out of box and ask what they are, there are pairs of similar vowel sounds , if we don’t have two to compare then we can’t use that vowel sound to test
Used to cross check PTA/VROA
- clinical folklore suggests that children obtain a score of 100% 20dB above threshold
Good way to build rapport
Not ear specific, does not specific nature of hearing loss
KTT procedure
Check vocab
Start at 35dB after conditioning
Present first three items, 0-2/3 correct = raise by 5dB; 3/3 correct present all 10 items
<10/10 correct raise PL by 5dB
10/10 correct = end test
If they get 100% at 35dB their thresholds are around 15dB or better so happy with their hearing levels
Can be presented through audiometer but then there is no rapport building
Live voice benefits
child doesn’t have to wear headphones
can make it like a game
less confronting
can control how quickly you present the words
younger children prefer
Can use carrier phrase to make it less formal, more like a game, working with the child rather than them doing a test for you
Live voice cons
recorded presentation allows for easy manipulation of presentation levels
you have to control your voice
can’t test SRT with live voice
can’t be adaptive (up and down till we find SRT)
Scoring method
Phonemes vs. whole words
-phoneme scoring have issues with production
Key word vs loose key word
- flexibility with pronunciation
The SIP test
Speech Identification by Picture test (Birtles 2001)
Recorded, monosyllabic picture pointing test, 2.5 years and up
Aim to find SRT - AC or BC
For children who can tolerate headphones but can’t fully participate in play - basically a recorded KTT looking for SRT rather than 100%
3 lists of 5 words, 1 list of 5 words presented in a semirandomised order
Check vocab first
Hughson westlake thresholding used to determine SRT - where child can ID 2/3 words correctly
SRT within 5dB of 3FAHL - except for steeply sloping HF losses
NU-CHIPS
North-Western University-Children’s Perception of Speech
3+years
50 monosyllabic nouns represented as simple line drawings, 1 target 3 foils per page
via headphones or loudspeaker
Vocab check (from back of book, various points in the page)
NUCHIPs with MAST
Monosyllabic Adaptive Speech Test
Commonly used to
- cross-check audiometric results - quantify the effects of hearing loss in relation to normal; we have normative values for different age groups - evaluate hearing aid/FM fitting - determine if amplification may be beneficial
Procedure
- Present at 3FAHL + 30 - Use 5dB steps to estimate 50% level (usually 3-4reversals - Use 2 dB steps for the testing - continue until you have 13 reversals
Mast Normative Values
3yrs - mean threshold 30.08dBSPL
5yrs - 25.32dBSPL
7yrs - 21.42dBSPL
MRL rather than SRT
MAST as audiogram cross check
If you present through the headphones SRT (HL) should be 3FAHL +/- 10dB
Sound field the SRT (dBSPL) should be 3FAHL +25dB +/-10dB
For a steeply sloping loss it may be appropriate to use the average at 500Hz and 1000Hz rather than the 3FAHL
Within Normal Limits:
- if SRT = PTA; as indicated by case history, concerns etc. - SRT >PTA; Retrocochlear? APD? Other?
Hearing loss
- SRT < PTA; NOHL? - SRT = PTA; consistent - SRT> PTA; retrocochlear? APD? Other?
Mast for Device Evaluation
Can compare SRT of aided vs unaided
if the aided SRT 10dB above the average SRT for their age aid fitting is recommended
MAST contraindications
Do not use MAST to:
- Compare SRTs between the ears for decisions about aiding unilaterally or bilaterally - decide whether or not to continue aiding the poorer ear in an asymmetrical loss - binaural advantage extends beyond speech perception (localisation etc.)
Things like localisation are not taken into account
BKB/A
Bamford-Kowel-Bench/Australian Version
Hearing impaired (3FAHL >95dBHL) children aged 8-15years and normal hearing children 6years and up
auditory or lip reading test
50 key words in 16 sentences
Used to
- compare aided and unaided performance - measure progress of a rehab program
Scoring uses loose key word method
Can be performed in quiet, in noise, live voice or recorded or video
Children repeat what they have heard
PBK-50
Phonetically Balanced-Kindergated 50’s
Test of word discrimination
5-6years and up
50 PB monosyllables (or abbreviated list of 30)
First 5 items are practice, the child has to repeat the whole word for it to be correct
- open set - like AB list for child
Can be live voice or recorded
Can be used to find a PI function or determine aided benefit
Paediatric Speech Intelligibility Test (PSI)
Children 3yrs and above
Sentences and Monosyllables
Picture pointing
The test can be administered in quiet or noise
- competing sentences/message can be played to the ipsi ear, or contra ear. ICM and CCM competing material varied in level and performance functions established
Used to assess central and peripheral auditory function
- competing messages to measure central
The Plott Test
Children with profound hearing losses to help and inform rehab programs
5years and up
Performed with hearing aids
9 subtests, live voice, picture pointing
Can look at if they are using timing issues for example
VRISD
Visual Reinforced Infant Speech Discrimination
requires child to detect a change in stimulus
head turn response rewarded by visual stimuli - sounds tested in pairs
habituate child to a sound e.g. ba, then change it e.g. da - head turn - reinforce
- takes time to habituate all the pairs
Used to look at
- discrimination of place of articulation - perception of voice onset time - discrimination at different ages - aided ability - although time consuming and requires specialised equipment
