V: Special Considerations in Speech-Language Pathology Practice (AAC & Audiology) Flashcards
AAC
AAC (1)
forms of communication that either supplement and/or replace more conventional means of communication (typically referring to speech)
AAC
F2F (1)
face-to-face communication (refers to spoken communication)
AAC
developmental and congenital disorders associated with need for AAC (7)
autism spectrum disorders (ASD), cerebral palsy (CP), down syndrome, severe and refractory phonological disorders, childhood apraxia of speech (CAS), intellectual disability, spina bifida
AAC
acquired disorders associated with need for AAC (8)
brain tumor, stroke (cerebrovascular accident or CVA), spinal cord injury (SCI), traumatic brain injury (TBI), multiple sclerosis (MS), guillain-barre syndrome (muscle weakness caused by PNS damage), huntington’s disease (HD), head and neck cancers (HNCs)
AAC
FAPE, 1975 (3)
free appropriate public education, guaranteed by rehabilitation act of 1973 and IDEA 1990, requires that children with disabilities receive support free of charge as is provided to nondisabled students
AAC
IDEA, 1990 (1)
individuals with disabilities education act, stipulates that assistive technology must be provided if it is required as a part of a child’s special education, related services or supplementary aids and serviced
AAC
assistive technology act amendments of 2004 (2)
PL-108-364, mandated assistive technology centers in each state and territory
AAC
ADA (2)
americans with disabilities act, hospitals must provide effective means of communication for patients, family members and hospital visitors who are deaf or hard of hearing
AAC
unaided vs aided (1::1)*
use of only the body to communicate without external aids or equipment :: use of external equipment to assist with communication
*aided AAC devices may be: no, low, mid and/or high-tech
AAC
dedicated vs nondedicated devices
sole purpose is to assist with communication (typically face-to-face) by providing speech output :: commercially available and support a range of functions in addition to speech output
AAC
iconicity (2)
the association a person makes between a symbol and its referent, can be: opaque (symbol does not resemble referent), translucent (symbol resembles referent), transparent (symbol can be readily guesses)
AAC
static vs dynamic displays
display doesn’t change :: screen changes following use input
AAC
cosmesis (1)
aesthetic appeal of a device and whether it can be modified/personalized (colors, designs)
AAC
direct selection vs alternate access
select via touch or other means (eye gaze) :: scan choices and the user indicates a choice using a predetermined signal
AAC
common scanning patterns (5)
circular (simplest type of scanning where icons highlight in a circle until a selection is made), linear (row-by-row, left to right), row-column, top-bottom, group item (icons grouped into themes)
AAC
selection control techniques (3)
direct (inverse) scanning (hold and release), automatic (regular) scanning (cursor moves automatically and a selection is made when switch is activated), step scanning (1:1 correspondence between cursor movement and switch activation)
AAC
partner-assisted scanning (1)
communication partner presents choices to the AAC use
AAC
auditory scanning (2)
used when visual interaction with the device is not possible, choices are provided auditorily
AAC
switches (3)
used with scanning to make selections, may use multiple switches to tailor functionality specific to the patient, types: mechanical, electrical, pneumatic (uses inhalation/exhalation to activate), electronic
AAC
switch site hierarchy (7)
hands -> head -> mouth -> feet -> lower extremities -> upper extremities -> mind
AAC
types of AAC communicators (4)
vary by skill while using device, types: emerging, contextual, independent
AAC
four main reasons for communicative interaction
communication of wants/needs, information transfer, social closeness, social etiquette
AAC
four core competencies of communicative competence for AAC user
linguistic, operational (maintenance of device), social, strategic (compensatory strategies to circumvent limitations of device)
AAC
types of rate enhancement (3)
prediction (autocorrect), coding (alpha, alphanumeric, letter-category, numeric codes), message coding (alpha-letter encoding, abbreviation expansion, icon prediction, color coding)
AAC
organization strategies using types of displays (3)
grid displays (fitzgerald key system, schematic grid, pragmatic organization dynamic display or PODD), visual scene displays, alphabet displays (QWERTY, ABCD, vowels on the left and consonants following)
AAC
CCN (1)
complex communication needs
AAC
participation model (2)
a systematic approach on assessment and intervention focusing meeting participation requirements for routines and activities of typical peers, identifies barriers of opportunity and access
AAC
opportunity barriers (5)*
policy, practice, knowledge, skill, attitude
*these barriers are external
AAC
tangible symbol systems (2)
aka symbol assessment, used to determine: most abstract level of symbol representation that can be reliably used, smallest size symbol(s) that can be reliably used
AAC
feature matching (1)
the process by which the skills and needs of the client are matched against the features of various AAC systems (process to find the best/most fitting device for the individual)
AAC
vocabulary selection (5)
critical component of AAC intervention, use of core vocabulary (high-frequency words and phrases that are highly functional for the individual, use of fringe vocabulary (words and phrases that are specific to a topic/activity/individual, not used as frequently as core), also includes: developmental vocabulary (new words installed for training/vocabulary growth), coverage vocabulary (basic needs)
AAC
keyguard (2)
a plastic/plexiglass overlay used to help isolate each key/cell to improve accuracy of icon selection (avoids selecting the wrong icon), useful for people who use pointers and/or have tremor
AAC
types of speech output (3)
synthesized speech (computerized, test to speech or TTS), digitized speech (prerecorded messages), hybrid
aud
outer ear (5)
pinna, external auditory meatus (EAM), tympanic membrane (TM), auditory function:collect sounds and channel them to the middle ear :: non auditory function:protection
aud
TM (4)
tympanic membrane, a thin oval membrane that forms a partition between the outer ear and the middle ear, three layers (lateral epidermal, intermediate fibrous, medial mucosal), transduces sound aka acoustic vibration transformed into mechanical energy
aud
parts of the middle ear (4)
a six-walled air-filled cavity within the petrous portion of the temporal bone, houses three bones (malleus, incus, stapes) held into an ossicular chain via tensor tympani and stapedius muscles, ossicular chain suspended in the middle ear via five ligaments, eustachian tube
aud
eustachian tube
a mucosal-lined pathway (part of the middle ear) that ventilates the middle ear through the connection to the nasopharynx
aud
middle ear function (2)
overall function is to compensate for impedance mismatch (loss of sound energy) between the acoustic signals from the outer ear and the cochlear fluids of the inner ear, middle ear muscles serve to increase sensitivity of the auditory system for speech (for example, stiffens in background noise)
aud
inner ear (6)
resides in the petrous portion of the temporal bone, two functions (sense of hearing:cochlea :: sense of balance:semicircular canals and otolithic organs), portions include: bony labyrinth, cochlear structures, organ of corti (outer and inner hair cells)
aud
osseous labyrinth (4)
aka bony labyrinth, includes: semicircular canals (three canals responsible for angular movement), vestibule (chamber of sensory organs responsible for detecting linear movement), cochlea (contains end-organ of hearing)
aud
cochlear structures (4)
bony canal (base of cochlea:largest turn :: apex:smallest turn), membranous labyrinth: scala vestibuli (upper canal containing perilymph), scala tympani (lower canal containing perilymph), scala media (middle canal containing organ of corti and endolymph)
aud
organ of corti (2)
outer hair cells (tube shaped):serves as a biologic modifier increasing or decreasing sensitivity to sounds by changing length of hair cells :: inner hair cells (flask shaped):serve to process frequency, time and intensity information to the auditory pathway
aud
inner ear membranes (3)
reissner’s membrane (forms roof of scala media, risk of erupting), basilar membrane (forms floor of scala media, high frequencies processed at the base and low frequencies processed at the apex), tectorial membrane (responsible for shearing the steriocilia of the hair cells)
aud
inner ear function (6)
overall function is to change mechanical energy into hydromechanical energy and then into neural impulses: (1) stapes moves fluid in the scala vestibule to create a wave -> (2) fluid pushes on reissner’s membrane and creates a wave in scala media -> (3) tectoral and basilar membranes move and shear agains stereocilia -> (4) exciting hair cells converts energy to electrochemical -> (5) hair cells release neurotransmitter to create nerve impulses -> (6) neural impulses picked up by CN VIII
aud
coding frequency (3)
place theory (frequencies are encoded based on their place along the basilar membrane), temporal theory (auditory nerve is phase-locked to stimulus pattern and brain encodes that timing pattern), missing fundamental frequency (the absent fundamental frequency in a complex sound is what is heard)
aud
coding intensity (2)
as intensity increases: individual nerve fibers fire more often, a wider area of the basilar membrane is stimulated (greater number of nerve fibers activated)
aud
CN VIII (2)*
vestibulocochlear nerve (includes three fibers: inferior vestibular nerve, superior vestibular nerve, cochlear nerve), affarent fibers carry information (frequency, temporal, intensity) from the cochlea to the cochlear nucleus
*nerve innervation patterns: IHCs:one hair cell to many nerve fibers (divergent) :: OHCs:many hair cells to one nerve fiber (convergent)
aud
otoscopy (2)
a systematic visual inspection of the outer ear and surrounding tissue (external auditory meatus and tympanic membrane), pass criteria: normal appearance of all structures and no complaints of pain when pinna and/or surrounding tissue is manipulated
aud
intensity measures (4)*
decibel (dB – unit of measurement of intensity used in acoustics and audiometric testing), sound pressure level (dB SPL – intensity level based on absolute pressure measurement), hearing level (dB HL – reference of normal human hearing thresholds for each audiometric frequency tested), sensation level (SL – any measurement made above an individual’s threshold)
aud
audiogram x-axis vs y-axis
x-axis:aka abscissa expressed in Hz :: y-axis:aka ordinate expressed in dB HL
aud
frequency principals (4)
period (amount of time for one sine wave to complete cycle), pure tone (sound consisting of a single frequency), periodic sounds (repetitive and do note change, can be simple or complex), aperiodic sounds (cycles do not repeat, complex)
aud
sensitivity principals (3)
absolute sensitivity (ability to detect a faint sound), differential sensitivity (aka acuity, ability to detect differences/changes of frequencies), threshold (level at which a stimulus is perceived, lowest intensity to respond to stimulus 50% of the time)
aud
psychoacoustic and measurement principals (3)
intensity (magnitude/amplitude of a sound related to the perception of loudness), frequency (cycles per second of the signal in Hz, related to perception of pitch), sensitivity (ability to sense/detect stimulus)
aud
audiometer (2)
instrument used to quantify hearing by producing sounds (pure tones, speech, noise) at calibrated intensities delivered using transducers (headphones, bone oscillator, sound field speakers)
aud
broadband vs narrowband
broadband:signals that are complex aperiodic signals that contain all frequencies (aka white noise) :: narrowband:white noise with frequencies above and below a center frequency filtered out
aud
speech noise (2)
broadband noise containing frequencies between 300 and 300 Hz, used for masking during speech audiometry
aud
purpose of pure tone audiometry (5)
determines severity of hearing loss, helps to diagnosis type of hearing loss (conductive, sensorineural, mixed), helps to describe configuration of hearing loss, determines intensity level to use for audiological procedures, helps determine hearing aid/cochlear implant candidacy
aud
air conduction vs bone conduction audiometry
stimulates entire peripheral auditory system including conductive and sensorineural portions :: bypasses the conductive mechanism via bone vibrator placed onto mastoid
aud
audiogram (3)
documents air and bone conduction thresholds, one audiogram for each ear, x-axis:frequency in Hz :: y-axis:intnesity in dB HL
aud
pure tone average vs fletcher average
average threshold values based on thresholds obtained at 500, 1000, and 2000 Hz :: best two thresholds at 500, 1000, and 2000 Hz (supposedly more accurate)
aud
CHL (4)
conductive hearing loss, normal bone conduction thresholds, air conduction thresholds outside of normal range, results from problems associated with the out and/or middle ear
aud
SNHL (4)
sensorineural hearing loss, near-equal air and bone conduction thresholds (within 10 dB of each other), all thresholds outside of normal range, results from disorders of the cochlea and/or CN VIII
aud
mixed hearing loss
bone conduction thresholds outside of normal range given that air conduction thresholds are poorer than bone conduction thresholds (creating an air-bone gap)
aud
ABG (3)
air-bone gap, the difference between air and bone conduction thresholds of an audiogram revealing a mixed hearing loss, reflects the degree of conductive component contributing to the overall mixed hearing loss
aud
speech audiometry (4)
verifies results following pure tone audiometry, helps to determine site of lesion, provides an estimate of communicative functioning to help determine goals/course of treatment, used to determine speech recognition threshold
aud
SRT (2)
speech recognition threshold, the lowest hearing level of each ear in dB HL at which one can correctly recognize speech stimuli (usually spondees aka bisyllabic words with equal stress)
aud
SRT-PTA agreement (2)
when speech recognition threshold and pure tone average are no more than 6 dB distant from each other, used to validate pure tone testing
aud
SDT (2)
speech detection (awareness) threshold, lowest intensity level that speech can be detected in dB HL
aud
speech/word recognition testing (4)*
used to estimate one’s ability to understand everyday speech, phonetically balanced (PB) words/other speech stimuli are presented at supra threshold level, client responds (open or closed response) to speech stimuli in an given environment (quiet, with noise), scores are presented as percentages per presentation level(s) used
*PB max:maximum word recognition score
aud
clinical masking (3)
used to eliminate the participation of the nontest ear (by presenting noise) when evaluating the test ear to obtain valid thresholds, narrowband noise is used for masking during pure tone testing :: speech noise is used for masking during speech audiometry
aud
IA (1)
intramural attenuation, amount of sound intensity needed before actual transmission of sound arriving at the nontest ear/cochlea occurs (aka crossover)
aud
masking risks (5)
under masking, overmasking, shadow curve (test ear mimics responses from nontest ear), masking dilemma (masking when both ears have air-bone gaps), may result in errors in diagnosing
aud
BOA (3)
behavioral observation audiometry, a type of pediatric testing strategy that involves providing a stimulus and observing behavioral responses (eye blink, startle response), for children 7 months and younger
aud
VRA (3)
visual reinforcement audiometry, a type of pediatric testing strategy that involves conditioning a child to look at a visual reinforcer when a stimulus is presented and detected, for children 7 months through 2.5 years
aud
CPA (3)
conditioned play audiometry, a type of pediatric testing strategy that involves conditioning a child to perform a task (for example, drop a block into bucket) when a stimulus is presented and detected, for children 2.5 years and older
aud
occlusion effect (1)
when an individual resorts to speaking softly because their own voice sounds too loud
aud
paracusis willisii (1)
ability to hear better in noisy environments
aud
recruitment (2)
rapid growth of loudness perception one threshold is crossed, associated with sensorineural hearing loss
aud
immittance measurement (2)
to assess middle ear function, to differentiate between cochlear (CN VIII) and retrocochlear (brain stem) disorders, associated with acoustic impedance and acoustic admittance
aud
acoustic impedance vs acoustic admittance
opposition to the transfer of acoustic energy :: ease of sound flow through an acoustic system
aud
tympanometry (2)
dynamic measure of energy flow through the tympanic membrane and displayed on a tympanogram (graph plotting variation in air pressure and tympanic membrane compliance), x-axis:change in pressure in decapascals (daPa) :: y-axis:acoustic immittance and tympanic membrane compliance (how much sound passes through the TM or is bounced back into the external auditory meatus)
aud
acoustic reflex testing (3)
measure of the change in acoustic admittance of the ear caused by a contraction of the stapedius muscle when a high intensity is presented, helps to confirm middle ear disorders, helps to distinguish between sensory (cochlea) and neural (CN VIII) disease
aud
OAEs (6)
otoacoustic emissions, low-intensity sounds generated by the cochlea that travel back through the middle ear and are recorded in the external auditory meatus by a microphone, can be present or absent, can be used to screen for hearing loss in newborns/infants, assists in differential diagnosis of sensory (cochlear) and neural (CN VIII) hearing loss, monitors for ototoxicity
aud
present OAEs vs absent OAEs
if the OAE is present then it suggests normal cochlear function in the presence of normal middle ear function :: if the OAE is absent then it suggests there is some degree of hearing loss in the presence of normal middle ear function
aud
TEOAEs
transient-evoked otoacoustic emissions, tested using a broadband click signal at 80-85 dB SPL to stimulate a range of frequencies in the cochlea, absent when cochlear hearing loss is greater than 30 dB HL
aud
DP-OAEs
distortion-product otoacoustic emissions, tested using a pair of tones (F1 and F2) at 65 and 55 dB, absent when cochlear hearing loss is greater than 45 dB HL
aud
AEPs (3)
auditory-evoked potentials, a series of bioelectric responses/waveforms measured using surface electrodes and then averaged, waveforms reveal neural activity in response to acoustic stimuli along the auditory pathways
aud
ECochG (2)
electrocochleography, compares summating potential (response from cochlea due to basilar membrane and hair cell displacement) to compound action potential (neural response from CN VIII)
aud
ABR (3)
auditory brainstem response, measures response using click and/or tone pip (filtered click) signal, NOT a true hearing test rather it is only used to predict hearing sensitivity by measuring neural activity in the auditory pathway
aud
ASSR
auditory steady state response, a technique that uses a continuous frequency-specific signal (frequency modulated, amplitude modulated or both) to detect presence/absence of response
aud
MLR (2)
middle latency response, reflects activity of the auditory thalamocortical pathway
aud
anotia vs microtia
absent pinna :: small pinna
aud
atresia vs stenosis
absent/blocked external auditory meatus :: narrowing of external auditory meatus
aud
osteoma vs exostosis
benign bony tumor :: benign bony tumor due to swimming in cold water
aud
tympanic membrane perforation vs tympanosclerosis
hole in TM due to trauma or infection :: scarring of TM due to multiple perforations
aud
otitis media (2)
middle ear fluid, may be: infectious, chronic, acute
aud
cholesteatoma (1)
nonmalignant growth (often a foreign body making its way into the middle ear)
aud
ossicular discontinuity vs otosclerosis vs tympanosclerosis
trauma to one or more of the icicles (malleus, incus, stapes) :: stiffening of the ossicles :: formation of white plaques on tympanic membrane
aud
barotrauma (1)
traumatic injury due to change in atmospheric pressure
aud
glomus tumor (2)
neoplasm (mass of cells with vascular supply) in the middle ear, includes pulsatile tinnitus
aud
middle ear disorders vs inner ear disorders
typically result in conductive hearing loss :: typically result in sensorineural hearing loss
aud
damage to outer hair cells vs damage to inner and out hair cells
mild to moderate sensorineural hearing loss :: severe to profound sensorineural hearing loss
aud
autoimmune hearing loss (1)
associated with autoimmune disorders where the body may produce antibodies against its own tissues
aud
temporary vs permanent threshold shift
short-term shift in hearing sensitivity due to acoustic trauma/noise :: long-term shift in hearing sensitivity due to acoustic trauma/noise
aud
ototoxicity (1)
hearing loss caused by therapeutic agents or chemical substances
aud
longitudinal vs transverse fracture
disarticulation of ossicular chain :: temporal bone fracture that damages the membranous labyrinth of the cochlea
aud
perceptual consequences of cochlear hearing loss (4)
loudness recruitment (disproportionate increase in sensitivity to loudness), dysacusis (difficulty understanding speech), diplacusis (one sound heard as two), phonemic regression (difficulty with word recognition)
aud
meniere’s disease
results from overproduction of inner ear fluid, causes vertigo (balance) and nausea, remediated via: surgery, medications, therapy
aud
retrocochlear disorders (1)*
associated with CN VIII, brain stem, vascular and/or cortical damage
*red flags: unilateral high-frequency sensorineural hearing loss, unilateral tinnitus
aud
vestibular schwannoma (2)
aka acoustic tumors, typically one-sided
aud
APD (4)
central auditory processing disorder, difficulty interpreting auditory information even with normal peripheral hearing sensitivity, interventions include enhancement of signal-to-noise ratio, children benefit from auditory training therapy and compensatory strategies
aud
ANSD (3)
auditory neuropathy spectrum disorder aka auditory neuropathy/auditory dys-synchrony occurring in newborns/infants/children, evidence of normal cochlear function but abnormal auditory nerve function, cause unknown
aud
basic hearing aid components (4)
microphone (omnidirectional, directional, multi), amplifier (analog or digital), receiver (coverts electric signal into acoustic signal to ear), battery
aud
electroacoustic characteristics of hearing aids (5)
gain (amount of amplification), frequency response (amount of gain across frequency range), output sound pressure level (OSPL – maximum output), linear sound processing (when dB increase is equal at all levels), nonlinear sound processing (amount of gain is dependent on incoming sound)
aud
hearing aid styles (3)
behind the ear (receiver in ear, receiver in canal), in the ear (full shell, half shell, in the canal, completely in the canal), contralateral routing of signal (CROS – can be bilateral CROS)
aud
purpose of ear molds (5)
attaches behind the ear hearing aid, amplification, modifies hearing aid frequency response, prevents feedback, can be modified: venting (channel that runs through earmold), damping (acoustic filter), horn effect (enhancement of high-frequency response)
aud
basic cochlear implant components (4)
microphone, external sound processor (converts sound to digital), internal unit (converts digital to electrical), electrode array (implanted into scala tympani next to round window to stimulate CN VIII and auditory pathways)
aud
ABI (2)
auditory brainstem implant, only used for adults with neurofribromatosis (damaged auditory nerve)
aud
BAI (2)
bone anchored implants, components: microphone, externally worn processor (converts energy into vibration), titanium abutment and fixture (implanted surgically – soft headband used for children <5)
aud
FM vs IR systems for assistive hearing
frequency-modulated:uses wireless radio waves for signal :: infrared:uses wireless light waves for signal
aud
HAT (5)
hearing assistive technology, alerting devices (doorbells, for example), listening devices (amplifiers), text devices (captioning), vibrotactile aids (vibrations)
aud
terms for persons with hearing differences (6)
deaf and hard of hearing, audiometrically deaf, Deaf, hearing loss, hearing impaired/hearing impairment, hard of hearing
aud
manual communication options (3)
american sign language (ASL), bilingual-bicultural (Bi-Bi), manually coded english (MCE)
aud
PSE (2)
pidgin sign english, combines: american sign language, signed english, fingerspelling
aud
auditory assessment tools (10)
ling six sound test, early speech perception (ESP) test battery, meaningful auditory integration scale (MAIS – infant-toddler version available), parent’s teaacher’s evaluation of aural/oral performance of children (P/TEACH), glendonald auditory screening procedure (GASP!), the listening comprehension test-2, test of auditory comprehension (TAC), speech perception instructional curriculum and evaluation for children with cochlear implants and hearing aids (SPICE)
aud
auditory hierarchy of listening (4)
detection -> discrimination -> recognition and identification -> comprehension
aud
classroom acoustics (3)
noise (internal or external), reverberation, distance (between sound source and listener)
