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Advanced Diagnostic Audiology > w4 - Ax of APD (tests and categories) > Flashcards

w4 - Ax of APD (tests and categories) Flashcards

1
Q

How are APD TB, APD test, APD models, and APD categories different?

A
  • 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)
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2
Q

In clinics you follow a ____

A

test battery

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3
Q

Why don’t we follow models in clinic?

A
  • 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).
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4
Q

What are the 11 considerations for an APD diagnostic assessment?

A
  1. taking a comprehensive case history by interview
  2. completing a checklist/questionnaires through interview
  3. observing the case behaviour (how they respond to questions or directions)
  4. gathering additional information from a multidisciplinary team
  5. controlling over confounding factors (medication, attention, fatigue)
  6. conducting APD tests in a sound treated booth
  7. no single APD TB is suitable for every suspected individual
  8. the TB should be chosen based on: case hx, checklists, parent/teacher questionnaires, multidisciplinary team
  9. TB should include both verbal and nonverbal tests
  10. APD tests should have psychometric properties reported (sensitivity, specificty, reliability, vailidty)
  11. Have knowledge of what a TB evaluates
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5
Q

What information should you find out about in case history?

A
  • auditory and communication difficulties
  • family history
  • general and medical history
  • developmental milestones
  • comorbid conditions
  • medications
  • social development/behaviour
  • education/work history
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6
Q

Why should you take case hx, checklists, and questionnaires through itnerview?

A
  • Follow up questions
  • Observe the whole family (parent and child interaction)
  • Can help make decisions regarding the TB
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7
Q

Who is part of the APD multidisciplinary team?

A
  • slps
  • psychologists/psychiatrists
  • family drs, pediatricians, otologists
  • occupational therapists, optometrits
  • teachers
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8
Q

Explain controlling over confounding factors
a) medication
b) attention and fatigue

A

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

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9
Q

What happens if you dont take confounding factors into account?

A

can affect the results

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10
Q

How long is a childs attention span?

A

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

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11
Q

Why do you need to conduct APD tests in a sound treated booth?

A

This is important because: it maximizes control (no distractions), most tests include BGN (we need control over stimulus level)

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12
Q

Why do we need to include nonverbal Ax in the TB?

A

Help us to check if there is something wrong related to the entire auditory neural network

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13
Q

What are the 4 psychometric properties?

A

1) sensitivity
2) specificity
3) validity
4) reliability

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14
Q

What is sensitivity?

A

detecting disorder when present

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15
Q

what is specificity?

A

not detecting disorder when absent

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16
Q

what is reliability?

A

the consistency of a measure (whether the results can be reproduced under the same conditions)

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17
Q

What is validity?

A
  • the accuracy of a measure (whether the test measures what it is supposed to measure)
  • measuring auditory processing skills in the context of APD
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18
Q

Why do we need high levels of reliability and validity?

A
  • 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)
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19
Q

Depending on the test, it can evaluate what?

A

multiple levels and the integrity of the CANS
- left ear/brain
- right ear/brain
- brainstem
- interhemispheric regions

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20
Q

What are the 4 models of the APD TB?

A

1) the minimal TB or medical model
2) the bellis and ferre model
3) the buffalo model
4) the spoken language processing (slp) model

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21
Q

What is an important matter that all of the models acknowledge?

A

mitigating the impact of fatigue and low attention on test results

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22
Q

Explain the 7 steps of the minimal test battery (MTB) model

A

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

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23
Q

What two tests make up the MTB TB?

A

A dichotic task, duration pattern test/temporal gap detection test

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24
Q

What are the 4 concerns surrounding the MTB model?

A
  • 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
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25
Q

What is the only model that utilizes electrophys Axs?

A

MTB model

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26
Q

In relation to the MTB model, what is the performance intensity (PI) function OR PI-phonetically balanced (PB) function?

A
  • 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
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27
Q

Why do many audiologists use the MTB model?

A

Because it is a very short TB

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28
Q

What is the 4 aims of the bellis/ferre model?

A

To provide comprehensive understanding of APD by testing/collecting information n about:
- Auditory processing skills
- Language skills
- Learning abilities
- Cognitive function

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29
Q

Compared to the medical framework, the bellis/ferre model considers assessing what?

A

Non-auditory factors.

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30
Q

The bellis/ferre model consists of…

A

3 APD profiles
2 secondary APD profiles (subcategories)

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31
Q

Does the bellis/ferre model recommend certain tests to use?

A

No, it is up to you

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32
Q
  • What are the 3 APD profiles identified from the bellis/ferre model?
A

o 1) auditory decoding deficit
o 2) prosodic deficit
o 3) integration deficit

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33
Q
  • Bellis/ferre model: an auditory decoding deficit is characterized by what 4 things?
A

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

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34
Q
  • What is the primary site of dysfunction for an auditory decoding deficit (bellis/ferre model)
A

o The left PAC

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35
Q
  • Bellis/ferre model: a prosodic deficit is characterized by what 4 things?
A

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

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36
Q
  • Bellis/ferre model: an integration deficit is characterized by what 4 things?
A

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

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37
Q
  • What is the main difference between prosodic and integration deficits?
A

o For integration, the corpus callosum is essential

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38
Q
  • What are the two secondary APD profiles from the bellis/ferre model?
A

o 1) auditory associative deficit
o 2) output-organization deficit

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39
Q

a) What is an auditory associative deficit (bellis/ferre model)
b) poor results in…

A

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)

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40
Q
  • The PAC is the ____, and the SAC is the ___
A

o Core, belt/parabelt

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41
Q

a) What is an output-organization deficit (bellis/ferre model)
b) difficulties with…

A

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

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42
Q
  • Can combinations of profiles occurs in the bellis/ferre model?
A

yes

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43
Q
  • What 3 tests does the buffalo model consist of?
A

o 1) staggered spondaic word test (SSW)
o 2) phonemic synthesis test (PST)
3) speech in noise test

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44
Q
  • Buffalo model: explain the SSW
A

o SSW is the core of the buffalo model
o The staggered presentation challenges auditory processing

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45
Q
  • Buffalo model: what do poor results in PST suggest?
A

o The decoding subtype of APD

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46
Q
  • Buffalo model: what do poor results in SIN tests suggest?
A

o Tolerance-fading memory (TFM) subtype of APD (the ability to remember information for a short period of time

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47
Q

a) Buffalo model: explain TFM
b) also show difficulties in…

A

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

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48
Q
  • By just using 3 Ax, you get more information with the ____ model rather than the ____ model
A

o Buffalo, bellis/ferre (the bellis/ferre doesn’t even list the Ax to use)

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49
Q
  • What are the 4 APD subtypes described in the buffalo model?
A

o 1) decoding
o 2) tolerance fading memory
o 3) integration
o 4) organization

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50
Q
  • How does the buffalo model explain the subtype of decoding? Poor results in…
A

o Phonemic processing (in identifying, manipulating, and remembering phonemes)
o Oral reading, word accuracy, spelling skills, and proeessing rapid speech stimuli

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51
Q
  • How is the buffalo subtype of decoding similar to the BF model?
A

o Same as auditory decoding deficit profile

52
Q

a) How does the buffalo model explain the subtype of tolerance fading memory? Poor results in…
b) commonly seen in?

A

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

53
Q
  • Is the TFM subtype included in the BF model?
A

No

54
Q

How long is STM?

A

o Typically less than 20 sec (but case by case; inter subject variability)

55
Q

How does the buffalo model explain the subtype of integration? Poor results in (3)…

A

o Transferring interhemispheric information
o Severe reading and spelling problems
o Integrating visual and auditory information

56
Q
  • How is the buffalo subtype of integration similar to the BF model?
A

o Same as the integration deficit profile

57
Q

a) How does the buffalo model explain the subtype of organization? Poor results in…
b) commonly seen in?

A

o Organizing, planning, and sequencing tasks
o Reversals (repeating stimuli out of sequence)
o Commonly observed in individuals with attention disorders

58
Q
  • How is the buffalo subtype of organization similar to the BF model?
A

o Same as the output-organization deficit profile

59
Q
  • The buffalo model provides ____ quantitative and qualitative indicators
A

34

60
Q
  • Buffalo model: what are quantitative indicators based on?
A

o Number of errors in 3 tests

61
Q
  • Buffalo model: what are qualitative indicators based on?
A

o Behavioural observations during testing (Checklists, questionnaires, case hx)
o Additional analyses within and/or between tests

62
Q
  • Explain the spoken-language processing model
A

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

63
Q
  • The SLPM assesses what 8 things?
A

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

64
Q
  • Why do audiologists not use the SLPM model in clinical practice?
A

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

65
Q
  • Current models of APD TB only rely on ____, not ____
A

o Behavioural auditory processing tests, not electrophysiologic tests

66
Q
  • What are the benefits of including electrophysiologic tests in the APD TB (4)?
A

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

67
Q
  • Explain speech ABR
A

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

68
Q
  • What are the challenges/limitations of including electrophysiologic tests in the APD TB?
A

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

69
Q
  • What are the 5 categories of an APD diagnostic test? What do each assess?
A

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

70
Q
  • What is dichotic listening?
A

o DL involved presenting different stimuli simultaneously to each ear

71
Q
  • DL tests have variations based on what?
A

o Stimuli and linguistic load (monosyllabic words to short sentences)
Task difficulty/requirements

72
Q
  • What are the 2 AP skills assesses by DL tests?
A

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)

73
Q
  • What are DL tests sensitive to?
A

The brainstem, cortical, and/or callosal lesions

74
Q
  • What are 3 commonly used DL tests?
A

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

75
Q
  • DDT age
A

o > 7 years

76
Q
  • DDT: test structure
A

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

77
Q
  • DDT instruction
A

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.

78
Q
  • DDT: scoring method
A

o Each ear score is compared with age-appropriate norms

79
Q
  • SSW: aim
A

o To detect possible lesions in the brainstem or cortical areas

80
Q
  • SSW: stimulus presentation
A

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

81
Q
  • SSW: age
A

o 11 and up

82
Q
  • SSW: stimuli
A

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)

83
Q
  • SSW: scoring and interpretation
A

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

84
Q
  • Why is the SSW such a complex task?
A

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)

85
Q
  • Ipsilateral-contralateral competing sentence test (IC CST): age
A

o 11 and up

86
Q
  • ICCST: stimulus presentation
A

o Monaural/dichotic under headphones in a quiet testing environment
o sentences

87
Q
  • ICCST: testing protocols
A

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

88
Q
  • ICCST: SNR
A

o -10 or -15 dB (this is a very tough test and shows why its important to look at APD TB case by case)

89
Q
  • ICCST is mostly a test of ____, not APD
A

o Attention

90
Q
  • Monaural low-redundancy speech tests: aim
A

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)

91
Q
  • MLRST: 3 commonly used tests
A

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

92
Q
  • Low pass filtered speech test: aim
A

o To assess speech perception ability when high frequency components are removed, leading to reduced clarity and intelligibility

93
Q
  • LPFST: stimulus presentation
A

o Monaural under headphones/speakers in a quiet testing environment

94
Q
  • LPFST: stimuli
A

o Low pass filtered monosyllabic words or sentences
o The filtering ranges from mild to severe

95
Q
  • LPFST: scoring and interpretation
A

o Percentage of correctly identified words or sentences
o The results are compared with age appropriate normative data

96
Q
  • Time compressed speech test: aim
A

o To test the ability to understand rapid speech rates by distorting/degrading the speech signal

97
Q
  • TCST: stimulus presentation
A

o Monaural under headphones in a quiet testing environment

98
Q
  • TCST: stimuli
A

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

99
Q
  • TCST: scoring and interpretation
A

o Percentage of correctly identified words or sentences
o The results are compared with age appropriate normative data

100
Q
  • Why is TCST difficult for those with APD?
A

o They don’t have that background information (they never had the chance to learn how to fill in these blanks)

101
Q
  • Explain the synthetic sentence identification test with ipsilateral competing message (SSI-ICM)
A

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)

102
Q
  • Who is the SSI-ICM test difficult for?
A

o Very difficult for a person with ESL, APD, and ADHD (they could never complete this test)

103
Q
  • SSI-ICM: aiM
A

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

104
Q
  • SSI-ICM: stimulus presentation
A

o Monaural under headphones/speakers in a quiet testing environment

105
Q
  • SSI-ICM: age
A

o 11 and up

106
Q
  • SSI-ICM: stimuli
A

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

107
Q
  • SSI-ICM: scoring and interpretation
A

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

108
Q

What are auditory temporal processing and patterning tests (ATPPT) assessing?

A

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

109
Q
  • ATPPT: why important
A

o Necessary for discriminating rapidly changing spectro temporal features in speech sounds
o Essential for perceiving prosodic aspects of speech (rhythm, stress, intonation)

110
Q
  • ATPPT: 3 widely used tests (what does each test assess)
A

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

111
Q
  • ATPPT: 2 additional tests
A

o Auditory fusion test
o Backward and forward masking test

112
Q
  • What are the 6 rapidly changing spectro-temporal features in speech sounds?
A

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

113
Q
  • GIN: aim
A

o To detect deficits in temporal resolution perception

114
Q
  • GIN: stimulus presentation
A

o Monaural under headphones in a quiet testing environment

115
Q
  • GIN: age
A

o 6 and up

116
Q
  • GIN: stimuli
A

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

117
Q
  • GIN: scoring and interpretation
A

o The percentage of correct gap detections
o The results are compared with age appropriate normative data

118
Q
  • FPT: aim
A

o To assess the ability to discriminate changes in frequency/pitch

119
Q
  • FPT: stimulus presentation
A

o Monaural under headphones in a quiet testing environment

120
Q
  • FPT: age
A

o 8 and up

121
Q
  • FPT: stimuli
A

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

122
Q
  • FPT: scoring and interpretation
A

o The percentage of correctly identified frequency patterns
o The results are compared with age appropriate normative data

123
Q
  • DPT: aim
A

o To assess the ability to discriminate changes in temporal patterns

124
Q
  • DPT: stimulus presentation
A

o Monaural under headphones in a quiet testing environment

125
Q
  • DPT: age
A

o 11 and up

126
Q
  • DPT: stimuli
A

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

127
Q
  • DPT: scoring and interpretation
A

o The percentage of correctly identified duration patterns
o The results are compared with age appropriate normative data

Advanced Diagnostic Audiology (11 decks)

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