unit 1 Flashcards
aural rehabilitation (AR)
seeks to restore a person’s ability to communicate (re-teaching)
aural habilitation
seeks to establish or improve a child’s ability to communicate (cannot re-teach what they never had)
what is the AR plan?
assessment, informational counseling, develop a plan, implementation, outcome assessment, and follow up
what are the two models for AR?
evaluation (activity limitations/restrictions, audiologic status, and life factors) AND intervention (AR strategy, listening devices, other services, and outcome assessment
goals of AR
minimize, alleviate hearing related difficulties ; improves conversational fluency, improved feeling of self-concept, better quality of life
disabiling hearing loss
there is a loss of function imposed by hearing loss and denotes a multidimensional which many include pain or discomfort (only about 30% of adults will do something about their hearing loss)
what does ICF stand for
international classification of functioning, disability and health
ICF framework
body structure, activity, body functions, participation, environmental factors, activity limitations, personal factors, participation limitation
impact of hearing loss on family members
“third party disabilities” in their own lives
why is AR needed for infants and toddlers
early identification, and prevention of speech and language delays
why is AR needed for school age children
academics and communication with peer groups are high priorities
-educational planning, accommodation in the classroom with assistive technology. and support in transition
why is AR needed for adults
adults can continue to make contributions in workplace and communities
why is AR needed for older persons
many want to continue career or desires to communicate with friends and family
-with health advances, hearing loss is the only thing holding them back
evidence based practice
clinical decisions for patient care should be based on :
-clinical expertise
-patient values
-best research evidence (real ear measurements)
-not “this is what we’ve always done”
what does PICO stand for
patient intervention comparison outcome
prelingual
HL acquired before acquisition of spoken language
perilingual
HL during acquisition of spoken language
postlingual
HL after acquisition of spoken language
congential
HL present at birth
acquired
HL from prevocational, early working age, later working age, retirement age
progressive hearing loss
occurs over the course of several months
sudden hearing loss
individual loses hearing suddenly, possibly due to an injury
speech clarity
dominated by high frequency volumes (CONSONANTS)
speech volume
dominated by low frequency volumes (VOWELS)
what conveys the most word information
consonants - therefore more important for speech intelligibility
speech perception testing
determine need for amplification, compare performance with and without listening device, compare different listening devices, determine needs for AT/placement in training program/expected benefit
speech recognition tests
assesses how well someone understands, often referred to as word recognition scores
-sound segregation and sound localization
speech awareness threshold/speech detection threshold (SAT/SDT)
the lowest level that the patient can just detect the presence of speech 50% of the time
-spondee words
-should be within 5-10 dB HL of pure tone threshold
speech recognition threshold (SRT)
lowest level at which the patient can perceive words with 50% accuracy (repeat the words back)
-spondee words
-should be within 6-12 dB of pure tone average
word recognition scores (WRS)
pure tone thresholds determine degree and type of hearing loss
-used to find a reduction in clarity
most comfortable level (MCL)
level that is most comfortable for the listener
uncomfortable loudness level (UCL)
intensity at which speech becomes uncomfortably loud
dynamic range (DR)
difference between the softest level that words can be understood and the level where speech starts to be uncomfortable
signal to noise ratio (SNR)
difference between the level of the signal and the level of noise
signal - noise = SNR
basic components of hearing aid
microphone, amplifier, receiver, battery, body of hearing aid, wax protector, telecoil, and program switch
omnidirectional microphone (omni)
sensitive to sound coming from all directions
directional microphone
more sensitive to sound originating on front of the user than to sound coming from behind the user (fixed vs. automatic vs. adaptive)
fixed directional microphone
picking up sound from the specific area
automatic directional microphone
switch in and out of directionally automatically (condenses into one area based on hearing background noise)
adaptive directional microphone
will change the direction of the way it is pointing (moves where speech is)
amplifier
gain = output - input
-how much sound comes out of the hearing aid
linear gain
one to one
compression
a nonlinear forms of amplifiers gain used to determine and limit output gains as a function of input gain
gain regulation
limit output of HA without distortion, minimize loudness discomfort, prevent further damage, restore normal perception, maintain listening comfort, reduce adverse effects of noise, provide varying amount of gain as a function of input level
recievers
like a speaker (pumps out the sound)
-low power = low HL
-high power = high HL
what do we fit domes based on
fitting based on acoustics
function of dome
are put on ends of receivers to fit in the ear (come in packs)
holes on domes - allows sound to go in normally
full domes - restrict all bass and sound from coming in
function of earmold
will help seal off the ear so leaking of sound (whistling) will not occur
-used for higher hearing loss patients since they need more sound output
what do we use to fit a earmold
patients hearing loss
how do we determine a dome or earmold
case by case
-look at hearing loss
-if they have a latex allergy
-if they have other situations that prevent from putting domes in
how to determine the style of hearing aids
based on the anatomy, hearing loss level, and what the patient wants
in the ear hearing instruments (ITE)
custom made
completely in the canal, in the canal, and in the ear
behind the ear hearing instruments (BTE)
behind the ear and receiver in the canal
completely in the canal (CIC)
-fits deeply inside the ear canal
-for mild to moderate losses
-reduces feedback and improves sound localization
-virtually invisible
in the canal (ITC)
-small enough to fit almost entirely in canal
-generally for mild to moderately sever losses
-easy for patients with arthritis
in the ear (ITE)
-fits in external ear
-generally for mild to severe losses
-similar to ITC, but a little bigger
behind the ear (BTE)
-fits snugly behind the ear and is attached to a custom earpiece
-for mild to profound hearing loss
-fewer problems with feedback and easy maintenance
receiver in the canal (RIC) or receiver in the ear (RITE)
-smallest BTE style
-for mild to profound hearing loss
-comprised of a smaller body that sits behind the ear with receiver in the ear
-most popular style
levels of hearing aid technologies
basic, essential, advanced, and premium
other features of a hearing aid
on/off control, direct audio input (DAI), wireless capability, telecoil, volume control, remote control (now used alongside an app). memories and programs, fall detection, and some waterproof models are coming out
one hearing aid vs. two hearing aids
-localization is impacted (need information from both ears to learn where sound is coming from)
-listening in noise (we use two ears to separate sound in noise ; if only using on, it can overwhelm the ear)
-loudness summation (two input levels of same frequency in the same ear will give it the same boost)
contralateral routing of signal (CROS)
sound will be transferred from bad side to the good side
-normal hearing in one ear and no hearing in the other ear
bilateral contralateral routing of signal (BiCROS)
amplifies the loss in the better of the two sides plus transferring noise from the worse side to the better side
-impaired hearing in one ear and no hearing in the other ear
limitations of hearing aids
only makes sound louder, cannot bypass the site of lesion, cannot selectively amplify speech versus noise, and other devices may be needed for warning sounds and alarms
verification
means to determine the hearing aid meeting a set of standards, including standards of basic electroacoustic, real ear measurements and comfortable fit
validation
determining the extent to which hearing related disability has been reduced
-speech recognition testing in soundfield (with and without hearing aid)
real ear measurments
gold standard for hearing aid verification
-speech map that represents what they hear at a certain level
functional gain (FG)
the difference between aided and unaided
basic care of hearing aids
-clean off skin and/or cerebrum
-do not get them wet
-do not sleep with hearing aids in
-do not drop them
-keep away from children and pets
-turn them off when not in use
cochlear implant (CI)
electronic device that stimulates the auditory nerve through electrodes placed in the cochlea
-directly stimulating auditory nerve
-acoustic to acoustic
-permanent
frequency at the cochlea
sensitivity with higher at the base and lower at the apex
patients hear through ______________, not mechanical energy
electronic stimulation
parts of the cochlear implant
receiving antenna, internal magnet, receiver and electrode array (each electrode will stimulate a certain frequency)
parts of a speech processor (external CI)
microphone, external magnet, and transmitter (gives the sound to interior implant parts)
how does a cochlear implant work
bypasses non functioning hair cells through pulses to send through auditory nerve
-temporal cues
steps of a cochlear implant
sound gets picked up by the microphone then its transmitted inward (band filters for each electrode)
biomodal CI
wears a cochlear implant on one ear and a hearing aid on the other ear
hybrid CI
wears a cochlear implant and a hearing aid combined
CI candidacy
if they fall into certain hearing threshold ranges they can be a candidate
-use speech scores to determine as well
-severe to profound hearing loss when hearing aids will not help to improve hearing
adult indication for CI
different manufacturers each have their own thresholds and also speech recognition thresholds
-specific on type of test (open set - nothing to read off of)
-best aided listening (HA for at least 6 months and using real ear measurements to help prove you have done it to the best)
pediatric candidacy for CI
based on the audiogram and auditory progress
-varies on age
-HAVE to hit the criteria
-more cautious for implantation
predicting factors for success with CIs
we don’t know who will do well or not but :
-length of hearing loss
-age hearing loss was acquired
-age of implementation
-length of time using implant’s and/or hearing aids
-quality of learning/support structure
contraindications
-hearing loss originating in auditory nerve or central auditory pathways
-cochlear ossification preventing electrode insertion
-cochlear nerve deficiency
-prone to ear infections
-TM perforations from middle ear infections
-allergy or intolerance of device materials
-lacking cognitive ability to use auditory cues and/or unwillingness to undergo an extended program of rehab
bone anchored hearing aids (BAHAs)
a type of hearing aid that delivers sound via bone conduction
-electromagnetic transducer
-NOT permanent
electromagnetic transducer
converts an electrical current into mechanical energy
-acoustic information into vibrations (electrical current)
parts of a BAHA
microphone, programming port cover, battery compartment attachment for safety line, program button, snap connector, processor (snaps on abutment), abutment (attaches to implant), and titanium implant (goes into skill and attaches to abutment)
candidates for BAHA
conductive hearing loss, single sided deafness, some degree of SNHL, cannot wear hearing aids. congenital malformations of the external/outer ear
BAHAs and audiometric thresholds
test how normally would
-bone conduction thresholds can determine candidacy
-devices have different strengths to accommodate different hearing loss
percutaneous implant
titanium fixture is surgically implanted into skull
-directly vibrating the skull
transcutaneous implant
titanium component that is implanted into the skull is coupled to magnetic plate that rests on the top of the skull at the mastoid bone
hearing assistive technology (HAT)
listening, alerting, and/or signaling devices that facilitates a patients communication with the environment
-enhances persons safety
assistive listening device (ALD)
are a part of HAT
hardwired systems
listener wears a headphone and they hold it out to whatever they want to hear or have the speaker hold it and speak into it
-good for one on one conversations
-not prescribed for hearing loss
wireless systems
wireless transmission of a signal to a receiver
frequency modulation (FM)
device transmits sounds through radio waves to the receiver
-often seen is educational settings
-large systems : i.e. Gammage or churches
-personal systems : i.e. one on one
infrared systems
transmitter/emitter send the signal through infrared light signals
bluetooth
wireless technology standard used for exchanging data between fixed and mobile devices
-loud and clear for both ears
-most HA today have a way to connect to any devices
telecoil (t coil)
a tiny coil inside a HA or CI that picks up electromagnetic signals given off by other devices
-orientation DOES matter !!
-will transfer the signals directly to the listener
what do HAT deliver sound to
the patients prescription
auditory training (AT)
training the brain to listen and interpret what the ears hear by developing listening activities and strategies
-retraining the brain to interpret the signal
candidates for AT
individuals with hearing loss using HA, cochlear implant users, auditory processing needs, APD, and ESL
what does SNHL impair
impairs clarity of speech
what does conductive hearing loss impair
impairs sensitivity of speech
goals of AT for adults
develop the ability to recognize and understand speech using the auditory signal, and to interpret auditory experiences
what are the estimates of hearing loss individuals
-only about 40-60% of hearing aid users are satisfied with their overall experience
-only about 25% of adults with hearing loss use hearing aids
frequency selectivity
ability to respond differentially to different frequencies or bands of frequencies
-complex sound into frequency components
temporal resolution
ability to discriminate sound segments occurring closely in time as separate events
-if a person requires longer silent gap between two sounds to recognize the gap
perceptual effort
perceptual effort is needed to encode speech into memory
-people with hearing loss often expend MORE perceptual effort when listening to speech
working memory and long term memory
cognitive systems needs to temporarily store information needed to perform speech perception task
-maintain information for extended periods of time
-fewer cognitive resources may be available to process what is being heard
neural pruning (atrophy or neural reorganization)
when pathways in the brain are clipped or damaged
-sometimes there is too much damage to bring back ‘normal’ hearign
listening to speech with hearing aids
only assist with audibility
-cannot resolve problems with peripheral issues of frequency and tempora
plasticity
physiological changes in the central nervous system that occur asa result of sensory experiences
-reorganizing to make up for lost of tracts
-the ability to change
neuroplasticity is the brains ability to change as a result of…
experiences, behavior, environment, and sensory deprivation or stimulation
hearing vs. listening
-listening is the process of breaking down what is being said
-hearing is involuntary, it is automatic
benefits of AT
may accelerate and supplement the process of brain recognition after receiving a HA or CI
analytic approach of AT
emphasizes the recognition of individual speech sounds and/or syllables
synthetic approach of AT
emphasizes the understanding of meaning and not necessarily the comprehension of every spoken word
bottom up processing and AT
sound processing influenced mainly by sound input from the auditory periphery, with minimal cognitive processing
top down processing and AT
use expectations based on contextual evidence, prior social linguistic knowledge
erber’s hierarchy
defines different levels of auditory processing
-detection : you hear it or don’t
-discrimination : telling one sound from another
-identification : recognizing object/word in enviornment
-comprehension : taking in a bigger picture meaning/understanding
form vs. meaning
-form : no semantic information
-meaning : semantic information
-can do it through phoneme, word, sentence, and discourse based
transfer appropriate processing theory (TAP)
greater the overlap between what is trained and what the desired outcomes are, the greater the training benefits will be
-most effective with a single talker
-train with stimuli that is most important
lipreading
when a person relies only on visual signal provided by talkers face
-visual speech signal!
what makes lipreading difficult
visibility of sound, rapidity of sound, coarticulation/stress effect, visemes and homophenes, and talker effects
visemes
groups of speech sound that appear similar on the lips/face (i.e. b, m, p)
homophones
words that appear similar on the mouth (i.e. matt tracked its dog, bess stacked hotdogs)
visual fixation
eyes fixate gaze on a single target
saccade
rapid and intermittent eye movement
speechreading
combines vision and hearing to produce an improvement in speech understanding
-all visual clues accompanying speech
crossmodal enhancement
occurs when the response to a stimulus presented through one modality is augmented or modulated by another stimulus presented through a different modality
the greater the _______, the greater the ________ on visual cues for communication
hearing loss ; reliance
factors that influence speechreading
the talker, the message, the environment/communication situation, and the speech reader
goals for speechreading
decrease depending on listening (allow to focus on whole picture), assist in the differentiation of speech sounds)
what is important to teach ?
self-advocacy
conversational style
the set of behaviors and methods that a person implements to relay and receive information during communication activities
communication strategy
a course of action taken to enhance communication
-teaching what things can do to enhance
emblematic hand gestures
culturally specific gestures
iconic hand gestures
depict an item, action, or feature of something being described
metaphoric hand gestures
gestures that depict a metaphor
deictic hand gestures
gestures that locate items, places, or people in space
-ASL
beat hand gestures
provide emphasis and serve an evaluative or orienting function
regulatory hand gestures
gestures that help guide the flow of conversation
successful communication with hearing loss is influenced by
-effectiveness of their listening device
-speechreading skills
-amount of residual hearing
some common concerns in a group discussion
talking on the phone, impatience on the part of a spouse, avoidance by old friends, isolation/loneliness, feelings of being left out, conversation in a noisy setting
passive conversational styles
taking what happens and not speaking up for themselves
-bluffs
-withdraws from conversation
-avoids social interactions to avoid difficulties
agressive conversational styles
acts demanding, hostile, and intimidating
-shifting blame
-excessive or expansive body gestures
-defense mechanism in a way
passive aggressive conversational styles
expressing aggression in a passive way
-use sarcasm and exhibit stubbornness
assertive conversational styles
what we want the patients to get towards
-takes responsibility for difficulties
-respects right of communication partners while honestly and openly express their needs and emotions
interactive communication behaviors
uses cooperative tactics, share responsibility for advancing conversation
-move forward together
noninteractive communication behaviros
passive conversational style, little contribution
-starting to go in the background
dominating communication behaviors
aggressive behavior takes extended speaking turns, interrupts
communication breakdown
when one communication partner does not recognize the message
factors for breakdown
speaker, environment, listener, and message
strategies to correct breakdowns
proactive : facilitative and anticipatory
reactive : repair
facilitative communication strategies
influence the talker, message, environment, or patients to enhance listening performance
-before breakdown occurs
-message tailoring strategies
-acknowledgment gestures
-constructive, adaptive, and anticipatory strategies
constructive strategy
elements that can be modified or exploited to optimize communication
adaptive strategies
counteracting bad effects of hearing loss
-help ease anxiety of certain situations
anticipatory strategies
doing things in anticipation of a breakdown
anticipatory communication strategies
can anticipate potential vocabulary and conversational content
-receive readily
-recognize genuinely
repair communication strategies
implemented by a participant in a conversation to rectify a breakdown in communication
-repeat
-rephrase
-elaborate
-simplify
-topic
-confirm
-provide feedback
-write
-fingerspell
social stigma
having a condition that is devalued because it deviates from the norm and results in a negative status being placed upon a person or group of persons
self stigma
occurs when a person stigmatizes ones own condition by feelings of embarrassment, and develops a spoiled self identity by virtues of having a shortcoming or disability
