w4 - Ax of APD (tests and categories) Flashcards
How are APD TB, APD test, APD models, and APD categories different?
- APD test battery: going through a series of tests
- APD test: a single test of APD
- APD models: a framework that has been designed
- APD categories: sublevels within a framework (tests within each category to target certain things)
In clinics you follow a ____
test battery
Why don’t we follow models in clinic?
- It is not feasible to complete an entire model within an Ax time (not enough time), can make a wrong assumption with a complex model, also, these are just “suggested” models.
- Many people choose a couple of tests from a specific model to make it more feasible (not including all of the suggested tests in a TB).
What are the 11 considerations for an APD diagnostic assessment?
- taking a comprehensive case history by interview
- completing a checklist/questionnaires through interview
- observing the case behaviour (how they respond to questions or directions)
- gathering additional information from a multidisciplinary team
- controlling over confounding factors (medication, attention, fatigue)
- conducting APD tests in a sound treated booth
- no single APD TB is suitable for every suspected individual
- the TB should be chosen based on: case hx, checklists, parent/teacher questionnaires, multidisciplinary team
- TB should include both verbal and nonverbal tests
- APD tests should have psychometric properties reported (sensitivity, specificty, reliability, vailidty)
- Have knowledge of what a TB evaluates
What information should you find out about in case history?
- auditory and communication difficulties
- family history
- general and medical history
- developmental milestones
- comorbid conditions
- medications
- social development/behaviour
- education/work history
Why should you take case hx, checklists, and questionnaires through itnerview?
- Follow up questions
- Observe the whole family (parent and child interaction)
- Can help make decisions regarding the TB
Who is part of the APD multidisciplinary team?
- slps
- psychologists/psychiatrists
- family drs, pediatricians, otologists
- occupational therapists, optometrits
- teachers
Explain controlling over confounding factors
a) medication
b) attention and fatigue
medication: taking regular prescribed medications to reduce the impact of confounding factors (ADHD, depression) - complete APD testing under medication
attention & fatigue: considering break periods during a test or between tests to prevent the fatigue impact
What happens if you dont take confounding factors into account?
can affect the results
How long is a childs attention span?
Need to offer breaks (especially for children)
- Add 2 minutes to the age and this is the maximum limit the child has to complete a test (attention span)
- Ex) 6 year old child = 8 min attention span
Why do you need to conduct APD tests in a sound treated booth?
This is important because: it maximizes control (no distractions), most tests include BGN (we need control over stimulus level)
Why do we need to include nonverbal Ax in the TB?
Help us to check if there is something wrong related to the entire auditory neural network
What are the 4 psychometric properties?
1) sensitivity
2) specificity
3) validity
4) reliability
What is sensitivity?
detecting disorder when present
what is specificity?
not detecting disorder when absent
what is reliability?
the consistency of a measure (whether the results can be reproduced under the same conditions)
What is validity?
- the accuracy of a measure (whether the test measures what it is supposed to measure)
- measuring auditory processing skills in the context of APD
Why do we need high levels of reliability and validity?
- We don’t want to say its APD if it isn’t
- Need to be smart in deciding what test to use
If a test isn’t reliable, if you do the test twice, results may not add up (if you get the same result twice, you can assume the test is reliable)
Depending on the test, it can evaluate what?
multiple levels and the integrity of the CANS
- left ear/brain
- right ear/brain
- brainstem
- interhemispheric regions
What are the 4 models of the APD TB?
1) the minimal TB or medical model
2) the bellis and ferre model
3) the buffalo model
4) the spoken language processing (slp) model
What is an important matter that all of the models acknowledge?
mitigating the impact of fatigue and low attention on test results
Explain the 7 steps of the minimal test battery (MTB) model
1) pure tone audiometry: to evaluate the integrity of the peripheral hearing system
2) immittance audiometry: to evaluate the status of the middle ear and aid in diagnosing auditory neuropathy
3) otoacoustic emissions: used to diagnose inner ear problems
4) ABR and MLR tests: to test the neural synchrony and integrity of the auditory brainstem and the cortex
5) performance-intensity functions for word recognition ability
6) a dichotic task: using words digits, or sentences to assess communication between the brain hemispheres
7) the duration pattern test & temporal gap detection test: to evaluate temporal processing aspects of APD
What two tests make up the MTB TB?
A dichotic task, duration pattern test/temporal gap detection test
What are the 4 concerns surrounding the MTB model?
- A medical framework (does not address the behavioural and educational concerns; a very audiological view of APD)
- Doesn’t use interviews (focuses on the medical side of things, not functional)
- Mostly diagnostic tests focused on lesions in the auditory system
- Focuses on physical damage
What is the only model that utilizes electrophys Axs?
MTB model
In relation to the MTB model, what is the performance intensity (PI) function OR PI-phonetically balanced (PB) function?
- It refers to the relationship between speech perception scores and increasing levels of sound presentation
- It measures how well a person can understand speech (usually words from a phonetically balanced word list) by increasing the speech presentation level
- The scores typically improve as the loudness increases until they reach a plateau, where further volume increases no longer result in better scores
- Its especially useful in diagnosing SNHL or retro-cochlear disorder
Why do many audiologists use the MTB model?
Because it is a very short TB
What is the 4 aims of the bellis/ferre model?
To provide comprehensive understanding of APD by testing/collecting information n about:
- Auditory processing skills
- Language skills
- Learning abilities
- Cognitive function
Compared to the medical framework, the bellis/ferre model considers assessing what?
Non-auditory factors.
The bellis/ferre model consists of…
3 APD profiles
2 secondary APD profiles (subcategories)
Does the bellis/ferre model recommend certain tests to use?
No, it is up to you
- What are the 3 APD profiles identified from the bellis/ferre model?
o 1) auditory decoding deficit
o 2) prosodic deficit
o 3) integration deficit
- Bellis/ferre model: an auditory decoding deficit is characterized by what 4 things?
o 1) poor performance in the right ear vs the left ear on specific speech tests (difficulty in the left brain and processing/decoding speech and language info)
o 2) poor phonemic representations, sound discrimination, and blending skills
o 3) difficulty in reading, vocabulary, and spelling
o 4) auditory fatigue
- What is the primary site of dysfunction for an auditory decoding deficit (bellis/ferre model)
o The left PAC
- Bellis/ferre model: a prosodic deficit is characterized by what 4 things?
o 1) poor performance in the left ear on dichotic tests (difficulty in the right brain and processing prosodic information, music, numbers)
o 2) difficulty perceiving and recogniszing nonverbal information (tonal patterns, singing ability, voicing patterns)
o 3) weakness in social communication
o 4) poor results in visual spatial tasks
- Bellis/ferre model: an integration deficit is characterized by what 4 things?
o 1) poor performance in the left ear on dichotic tests
o 2) poor performance in nonverbal tests
o 3) difficulty in interhemispheric skills, requiring the coordination of the 2 hemispheres (drawing, dancing, multitasking)
o 4) poor sound localization abilities
- What is the main difference between prosodic and integration deficits?
o For integration, the corpus callosum is essential
- What are the two secondary APD profiles from the bellis/ferre model?
o 1) auditory associative deficit
o 2) output-organization deficit
a) What is an auditory associative deficit (bellis/ferre model)
b) poor results in…
o Characterized by miscommunication between PAC and SAC (from what we receive in PAC and what we process in SAC)
o Poor results in tests of word recognition, dichotic, and receptive language (vocabulary, semantics, and syntax)
- The PAC is the ____, and the SAC is the ___
o Core, belt/parabelt
a) What is an output-organization deficit (bellis/ferre model)
b) difficulties with…
o Person performs well on simple tasks, but struggles with complex tasks
o Ex) sound blending (retaining and blending several sounds), sequencing, planning, and/or fine motor tasks
- Can combinations of profiles occurs in the bellis/ferre model?
yes
- What 3 tests does the buffalo model consist of?
o 1) staggered spondaic word test (SSW)
o 2) phonemic synthesis test (PST)
3) speech in noise test
- Buffalo model: explain the SSW
o SSW is the core of the buffalo model
o The staggered presentation challenges auditory processing
- Buffalo model: what do poor results in PST suggest?
o The decoding subtype of APD
- Buffalo model: what do poor results in SIN tests suggest?
o Tolerance-fading memory (TFM) subtype of APD (the ability to remember information for a short period of time
a) Buffalo model: explain TFM
b) also show difficulties in…
o It is proposed that TFM is a secondary deficit to APD
o Inability to retain auditory information, affecting the amount of information a person can handle at one time
o Additional to SIN difficulty, individuals often show:
Impatience, and easily get over-stimulated
Poor reading comprehension
Handwriting difficulty
- By just using 3 Ax, you get more information with the ____ model rather than the ____ model
o Buffalo, bellis/ferre (the bellis/ferre doesn’t even list the Ax to use)
- What are the 4 APD subtypes described in the buffalo model?
o 1) decoding
o 2) tolerance fading memory
o 3) integration
o 4) organization
- How does the buffalo model explain the subtype of decoding? Poor results in…
o Phonemic processing (in identifying, manipulating, and remembering phonemes)
o Oral reading, word accuracy, spelling skills, and proeessing rapid speech stimuli
- How is the buffalo subtype of decoding similar to the BF model?
o Same as auditory decoding deficit profile
a) How does the buffalo model explain the subtype of tolerance fading memory? Poor results in…
b) commonly seen in?
o Short term auditory memory
o Processing auditory information in the precesnce of noise
o Inhibiting responses (impulsivity)
o Commonly observed in those with ADHD
- Is the TFM subtype included in the BF model?
No
How long is STM?
o Typically less than 20 sec (but case by case; inter subject variability)
How does the buffalo model explain the subtype of integration? Poor results in (3)…
o Transferring interhemispheric information
o Severe reading and spelling problems
o Integrating visual and auditory information
- How is the buffalo subtype of integration similar to the BF model?
o Same as the integration deficit profile
a) How does the buffalo model explain the subtype of organization? Poor results in…
b) commonly seen in?
o Organizing, planning, and sequencing tasks
o Reversals (repeating stimuli out of sequence)
o Commonly observed in individuals with attention disorders
- How is the buffalo subtype of organization similar to the BF model?
o Same as the output-organization deficit profile
- The buffalo model provides ____ quantitative and qualitative indicators
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- Buffalo model: what are quantitative indicators based on?
o Number of errors in 3 tests
- Buffalo model: what are qualitative indicators based on?
o Behavioural observations during testing (Checklists, questionnaires, case hx)
o Additional analyses within and/or between tests
- Explain the spoken-language processing model
o Very heavily focused on speech and language
o The model views auditory processing as part of speech and language processing
o APD is a component of a broader speech and language disorder
- The SLPM assesses what 8 things?
o Lexical decoding
o Fading memory
o Auditory linguistic integration
o Sequencing
o Short term memory span
o Prosodic perception
o Attention
o Phonologic problems
- Why do audiologists not use the SLPM model in clinical practice?
o To time consuming
o Need to have the tests with available normative data
o Completely focused on speech and language
o Some audiologists find it difficult to relate the prevalence of this model to APD
- Current models of APD TB only rely on ____, not ____
o Behavioural auditory processing tests, not electrophysiologic tests
- What are the benefits of including electrophysiologic tests in the APD TB (4)?
o Speech ABR
o Provide information about neural synchrony and sound representation in auditory pathways
o Assist in testing patients with a lack of cooperation in behavioural tests
o Assist in monitoring improvements following intervention
- Explain speech ABR
o Speech/complex ABR uses stimuli such as /b/ “bbb” as stimuli instead of a click or pulse tone
o Speech ABR may be a game changer because when we use speech for recording an ABR< it gives us a lot of information
- What are the challenges/limitations of including electrophysiologic tests in the APD TB?
o Lack of availability in all clinical settings
o Require expertise and experience for testing and interpretation
o Impose additional costs
o Their normal results do not rule out APD
o Do not provide functional information: the ability to process and utilize auditory information
- What are the 5 categories of an APD diagnostic test? What do each assess?
o Dichotic speech tests (assess binaural separation and integration)
o Monaural low-redundancy speech tests (assess monaural separation/closure)
o Auditory temporal processing and patterning tests (assesses temporal resolution, nonspeech sound discrimination, temporal ordering)
o Binaural interaction tests (assesses binaural interaction)
o Auditory discrimination tests (assesses speech and/or nonspeech discrimination
- What is dichotic listening?
o DL involved presenting different stimuli simultaneously to each ear
- DL tests have variations based on what?
o Stimuli and linguistic load (monosyllabic words to short sentences)
Task difficulty/requirements
- What are the 2 AP skills assesses by DL tests?
o Binaural integration (reporting stimuli from both ears)
Basic DDT
o Binaural separation (only reporting stimuli from the target ear and ignoring competing signals from the other ear)
Can still do the DDT, but ask them to only repeat what they hear from the right ear (directed test)
- What are DL tests sensitive to?
The brainstem, cortical, and/or callosal lesions
- What are 3 commonly used DL tests?
o The dichotic digit test (DDT)
o The staggered spondaic word (SSW) test
o The competing sentences test (CST)
These get more difficult farther down the list
- DDT age
o > 7 years
- DDT: test structure
o Composed of naturally spoken digits from 1-10, excluding 7
o Includes 20-digit pairs for a total of 40 test items per ear
o Two different digits are presented to each ear simultaneously
o Conducted under earphones at 50 dB SL
- DDT instruction
o Two numbers are presented per ear (a 4back test) and the person should repeat all the numbers heard in any order. Guessing is encouraged.
- DDT: scoring method
o Each ear score is compared with age-appropriate norms
- SSW: aim
o To detect possible lesions in the brainstem or cortical areas
- SSW: stimulus presentation
o Dichotic under headphones in a quiet testing environment
o The first syllable of the first word and the second syllable of the second word are presented individually to the RE and LE. The other 2 syllables are overlapped and presented simultaneously
o This is known as cardinal numbers
- SSW: age
o 11 and up
- SSW: stimuli
o Spondaic words: 2 syllable words with equal stress on both syllables
o Consisting of 40 pairs of spondaic words (20 pairs for each ear)
- SSW: scoring and interpretation
o Quantifying the percentage of correctly identified syllables for 8 cardinal numbers
o Quantifying some specific types of errors such as omission or substitution of syllables
- Why is the SSW such a complex task?
o This is a complex test (gives you a lot of information on monaural information, binaural information, information at the level of the brainstem, etc)
o This covers a bunch of information by just performing one test (multiple tests in one)
- Ipsilateral-contralateral competing sentence test (IC CST): age
o 11 and up
- ICCST: stimulus presentation
o Monaural/dichotic under headphones in a quiet testing environment
o sentences
- ICCST: testing protocols
o 1) presenting both target signal (TS) and competing signal (CS) to one ear and requiring TS to be repeated
o 2) presenting TS and CS dichotically and requiring TS to be repeated
o 3) presenting TS and CS dichotically and requiring both TS and CS to be repeated
- ICCST: SNR
o -10 or -15 dB (this is a very tough test and shows why its important to look at APD TB case by case)
- ICCST is mostly a test of ____, not APD
o Attention
- Monaural low-redundancy speech tests: aim
o To test auditory closure: the ability to fill in missing components of a degraded signal and recognize the message in its entirety (someone with APD struggles to fill in the missing parts of speech)
- MLRST: 3 commonly used tests
o 1) the low pass filtered speech test
o 2) the time compressed speech test
o 3) the synthetic sentence identification test with ipsilateral competing message
- Low pass filtered speech test: aim
o To assess speech perception ability when high frequency components are removed, leading to reduced clarity and intelligibility
- LPFST: stimulus presentation
o Monaural under headphones/speakers in a quiet testing environment
- LPFST: stimuli
o Low pass filtered monosyllabic words or sentences
o The filtering ranges from mild to severe
- LPFST: scoring and interpretation
o Percentage of correctly identified words or sentences
o The results are compared with age appropriate normative data
- Time compressed speech test: aim
o To test the ability to understand rapid speech rates by distorting/degrading the speech signal
- TCST: stimulus presentation
o Monaural under headphones in a quiet testing environment
- TCST: stimuli
o Words or sentences
o They are digitally time-compressed between mild and severe (30 to 70%, 70% is the hardest) leading to increased speech rates
- TCST: scoring and interpretation
o Percentage of correctly identified words or sentences
o The results are compared with age appropriate normative data
- Why is TCST difficult for those with APD?
o They don’t have that background information (they never had the chance to learn how to fill in these blanks)
- Explain the synthetic sentence identification test with ipsilateral competing message (SSI-ICM)
o The SSI-ICM uses synthetically constructed sentences that are grammatically correct, but lack meaningful content (ex: small boat with a picture has become)
o These sentences are presented to the listener along with a competing message in the same ear (ipsilateral)
- Who is the SSI-ICM test difficult for?
o Very difficult for a person with ESL, APD, and ADHD (they could never complete this test)
- SSI-ICM: aiM
o To measure the ability to correctly identify the target sentence, while ignoring the competing signal
o Assessing auditory processing abilities in challenging listening environments
- SSI-ICM: stimulus presentation
o Monaural under headphones/speakers in a quiet testing environment
- SSI-ICM: age
o 11 and up
- SSI-ICM: stimuli
o The message signal consists of 10 synthetic sentences spoken by a single talker
o The competition signal is a male talker reading a passage
o The message to competition (MCRs) ratios: -20 to +10 dB per set of 10 sentences
- SSI-ICM: scoring and interpretation
o The MCR at which the listener can repeat back 50% of target sentences correctly
o The results are compared with age appropriate normative data
What are auditory temporal processing and patterning tests (ATPPT) assessing?
o To test auditory timing and pattern processing using non speech stimuli
o Testing temporal resolution and temporal ordering
o Gives us information about auditory timing and pattern processing
- ATPPT: why important
o Necessary for discriminating rapidly changing spectro temporal features in speech sounds
o Essential for perceiving prosodic aspects of speech (rhythm, stress, intonation)
- ATPPT: 3 widely used tests (what does each test assess)
o 1) gaps in noise (GIN) to assess temporal resolution
o 2) frequency pattern test (FPT) to assess temporal ordering
o 3) duration pattern test (DPT) to assess temporal pordering
- ATPPT: 2 additional tests
o Auditory fusion test
o Backward and forward masking test
- What are the 6 rapidly changing spectro-temporal features in speech sounds?
o 1) format transitions: rapid shifts in vocal tract rsonances (formats) between consonants and vowels
o 2) voice onset time: the time between the release of a stop consonant and the onset of voicing
o 3) stop consonant bursts: a brief burst of noise when the closure of a stop consonant is released
o 4) fricative noise: turbulent noise created by airflow through a narror constriction in fricatives
o 5) pitch contours in prosody: rapid change in pitch that convey intonation or emotion
o 6) dipthongs: vowel sounds that involve a rapid transition between 2 vowel qualities
- GIN: aim
o To detect deficits in temporal resolution perception
- GIN: stimulus presentation
o Monaural under headphones in a quiet testing environment
- GIN: age
o 6 and up
- GIN: stimuli
o A series of noise stimuli with brief gaps (2 and 20 ms) inserted at irregular intervals (constant noise presented at MCL)
o The individual responds by pressing a button or giving a verbal response
- GIN: scoring and interpretation
o The percentage of correct gap detections
o The results are compared with age appropriate normative data
- FPT: aim
o To assess the ability to discriminate changes in frequency/pitch
- FPT: stimulus presentation
o Monaural under headphones in a quiet testing environment
- FPT: age
o 8 and up
- FPT: stimuli
o A series of tone stimuli with varying frequency patterns (880 and 1122 Hz)
o 2 frequencies x 3 presentations = 6 different patterns
o The person is instructed to respond verbally or manually
- FPT: scoring and interpretation
o The percentage of correctly identified frequency patterns
o The results are compared with age appropriate normative data
- DPT: aim
o To assess the ability to discriminate changes in temporal patterns
- DPT: stimulus presentation
o Monaural under headphones in a quiet testing environment
- DPT: age
o 11 and up
- DPT: stimuli
o A series of tone stimuli with varying duration patterns (500 or 250 ms)
o 2 durations x 3 presentations = 6 different patterns
o The person is instructed to respond verbally or manually
- DPT: scoring and interpretation
o The percentage of correctly identified duration patterns
o The results are compared with age appropriate normative data
