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51 Cards in this Set

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"Fetus may hear sound in utero." Is this a ridiculous statement?
The cochlea has normal adult function at 20 weeks GA and reaches its final size and structure by 34 weeks. Johansson (1964): first to report testing fetal hearing. High frequency tones presented through abdomen. Fetal heart rate increased for fetuses >20 weeks GA. So babies start hearing from the 5th month of gestation.
List responses to sound that can be observed in a neonate
Auropalpebral Reflex (APR)
Moro Reflex
Changes in respiration, heart rate and sucking.
APR
Auropalpebral reflex (APR): eye blink in response to loud sound. Reliable response in neonates. Resistance to extinction (habituation). In a quiet room can reliably elicit APR reflex with broadband signals & speech signals at levels of 60-75 dB SPL (40-55 dB HL).
Moro Reflex
Startle response. Knees and arms drawn into body. Can elicit with speech signals above ~65 dB HL. Problem = can elicit even if handicapping high freq HL.
4 states and infant can be in during testing
Deep sleep, light sleep, awake & quiet, or awake & active.
Behavioral responses you might expect in response to sound from infants 0-6 weeks
APR & startle, change in pre-stimulus state (sucking, heart rate, respiration), eye-widening (later in this period).
Behavioral responses you might expect in response to sound from infants 6 weeks-4 months
Eye-widening, eye-shift, quieting, rudimentary head turn.
Behavioral responses you might expect in response to sound from infants 4-7 months
Head turn on lateral plane toward sound.
Behavioral responses you might expect in response to sound from infants 7-9 months
Direct localization to side, indirectly below.
Behavioral responses you might expect in response to sound from infants 9-13 months
Direct localization to side, below, indirectly above.
Behavioral responses you might expect in response to sound from infants > 13 months
Direct localization in all directions.
Define auditory perception
Interpretation of sensory evidence, produced by ears in response to sound, in terms of the objects & events that caused the sound.
Observer-based psychoacoustic procedure (OPP)
Observer says in s/he thinks the infant responded to sound during interval. Takes about 1 month to train (must have less than 25% false positive rate). Use in conjunction with visual reinforcement.
Conditioned orientation reflex/response audiometry (COR)
Based on the observation that infants will reflexively turn the head toward a novel auditory or visual stimulus. COR required accurate localization of sound source to be reinforced.
For what age group would you use VRA?
Infants 5 to 30 months.
VRA Procedures
1) Explain procedure to parent and caution about cuing.
2) Start with SF speech at low levels. Ascend and look for spontaneous response. Gives a ballpark idea of unconditioned MRL. Speech is the easiest stimulus to get a response. Can also give you an idea of the developmental level of response.
3) Speech stimuli: use earphones. Condition one-sided head turn. Need to justify using earphones because you need twice as many responses (each ear).
4) Warble tones: earphone or SF.
5) Must be speedy. Usually only have 15 min before child habituates.
Frequencies tested for VRA
2000, 500, 4000, 1000 Hz
Test environment for VRA/BOA
Simple, speakers at a minimum of 45 degrees, ideal to have a dimmer for VRA so R+ shows up more (at least have R+ behind dark plexiglass), good to have different reinforcers for variety.
Test environment for CPA and older kids
Need to make decision whether or not to have parent in the room. Child may "act out" instead of working if parent in room or child may be frightened. Bottom line - ask parent & child what they want.
Responsibilities of test assistant
Behavior management - distract without being distracting, centering, assist with conditioning procedure (VRA & CPA), management of parent, observation of behavior (BOA & VRA).
The test behavior is ______
Dynamic not static
Response-ready state/window
Not too distracted with toy, not talking or vocalizing, not interacting with parent, not looking at R+. As session progresses the periods of response-ready time decreases, it may vary with distractors depending on how much the child likes them. Stimulus presentation must be matched to response-ready window.
At what age would you use CPA procedures? Lowest age and typical age (initial session), lowest age (multiple sessions)
Lowest age (initial session): 2 years, 3 months
Typical age (initial session): 2 years, 8 months
Lowest age (multiple sessions): 18 months (AR kid)
Detection
Ability to detect the presence of a stimulus.
Identification (recognition)
The ability to recognize and identify a stimulus by pointing, repeating or writing (most of our word recognition tests).
Comprehension
The ability to understand what a stimulus means.
Ling 6-sound test
/a/, /u/, /i/, /s/, “sh”, /m/
Speech discrimination tests
Body parts, picture cards/spondees, PBK-50 word list.
PBK-50 word list
Developed by Hastins (1949). 3 lists of phonetically balanced words selected from spoken vocab of kindergarteners. Open-ended set of stim words. Presented MLV or tape recorded. Children < 4.5 years may not do well unless use play techniques. Tangible reinforcement is an effective method of maintaining interest. (Significant improvement found in children 4-8 years when used token reinforcement). Used to test when receptive vocab child approaches that of normal hearing kindergartener.
WIPI
Word intelligibility by picture identification. Developed by Ross & Lerman (1970). Developed for HI children. Evaluated test on 61 HI kids ages 5-6; should not use with children <5 yrs. 25 picture plates w/ 6 pictures/plate. Closed response set. Test has high reliability, simple & rapid to administer.
NU-CHIPS
Northwestern University Children’s Perception of Speech Test. Developed by Elliott & Katz (1980). 50 monosyllabic words – in vocab of children > 2.5 years. Includes 65 word pictures & interchanges 50 words as test items & foil items. Simple words (e.g. food school) represented in 4 AFC picture set. Child responds by pointing to picture.
SERT
Sound effects recognition test. Developed by Finitzo-Hieber et al. (1980). Developed for children w/ limited verbal abilities. 3 equivalent sets, each containing 10 familiar environmental sound (e.g. dog barking, toilet flushing, mother singing). Use as supplement to more traditional speech discrim tests – closed set, picture pointing, 10 sounds + practice sound.
PSI
Pediatric speech intelligibility test. Developed by S. Jerger et al. (1980, 1981). Used realistic speech materials to control receptive language factor in children incorporating actual responses of normal children between changes of 3-6 yrs. 20 monosyllabic words; 10-sentence procedures. Word lists= simple nouns, such as dog, spoon. Sentence construction Format I & Format II (nonsense “a bear is brushing his teeth.” Different sentence formats = different speech patterns of nml children betwn 3-6 yrs. Can use PSI test items in presence of competing message & defining PI functions for children of varying chronological & receptive language age groups – prior to this, only thought could do this testing in adults
The clinical implication from the Noza et al. (1999) study
Overall found 4 dB effect of nonsensory influences across freq, thus, there must be sensory diffs between infants & adults.
Clinical implications: average thresholds for infants 7-9 months of age at 500, 1000 & 2000 Hz differ from adult’s. These authors recommend infant nml thresholds as: 20 @ 500, 15 @ 1000, & 10 @ 2000 Hz. Variability between infants was not much greater than for adults.
Babies middle ear vs. adults middle ear (mass & stiffness)
Babies system is more mass dominated than stiffness dominated (adults).
What frequency tympanometry is used for infants 7 months and younger?
About 800 Hz
Frequency spectra of ABR for kids vs. adults
Adults: more energy in higher frequencies. Near threshold - concentration near 100 Hz.
Neonates: less frequency spilling. Much less high frequency info. Dominated by lower frequencies.
How do the difference in frequency spectra for kids change your filtering characteristics for ABR testing?
Need to open filters lower than what we would have done for adults. 100 Hz cut off for kids vs. 1500 Hz cut off for adults.
Recommendations 25 or 30 - 3000 Hz.
What are the drawbacks to using click stimuli for ABR testing?
Broadband signal, so we can’t determine hearing sensitivity for specific frequencies because clicks activate wide are of basilar membrane.
Why do we use a one sided head turn?
Initially takes more time to condition but when we switch ears the response will not extinguish. Requiring localization can be difficult near threshold or if you need to finish in the sound field and there is an asymmetrical hearing loss.
Requirements of a pediatric audiologist
1) Behavior management
2) Control bias
3) Recognized response ready window
4) Present tone during window
5) Switch up timing
6) Switch up types of tones
7) Flexibility
8) Patience
9) Speedy
10) Self evaluation
Issues in pediatric assessment of speech perception
1) The child's language
2) Cognitive and attentional capabilities
3) Articulation problems
4) MLV over recorded materials
5) A variety of tests are needed to measure speech perception
6) Children should not be trained on materials
Two applications of ABR
1) Estimate of hearing sensitivity
2) Identification lesions at 8th nerve and beyond
At lower intensities there is _____ variability in latency. At higher intensities there is ____ variability.
More, less
Amplitude ratio V/I for adults and infants
For adults the ratio is 2+
For kids ~1
Infants ABRs compared to adults
Kids ABR amplitudes are smaller, simpler waveform (only identify waves 1, 3, and 5), longer latency and we use a slower click stimulus (shouldn't go over 66)--> we need different norms for kids and adults.
The three latencies we look at
1) Absolute latencies of all waves
2) Inter-peak latency
3) Inter-aural differences
Bone conducted ABRs
Pretty rare because if it is not a kid we have other ways of getting this information. It is a way of backing up the ABR that we got. Can help us figure out if the results are sensorineural or conductive. Two-channel recordings.
Bone conduction thresholds (infants):
500 Hz: expected down to 20 dB nHL
2000 Hz: expected down to 30 dB nHL
What things can alter TEOAE measures?
Intensity of stimulus, status of middle and outer ear, functioning cochlea (SNHL), age (we need different norms for infants and adults, 10 dB different). (3 dB above noise floor, conservatively 6 dB).
DPOAE measures overview
Range between infants and adults (3-10 dB difference). The distortion is due to the non-linearity of cochlea. 1.2 ratio. Levels <70 should be 10 dB apart, at 70 dB they can be equal. L1 > L2 because we want them to arrive at the membrane at the same time. Want at least a 6 dB SNR or use template to identify a present DPOAE.
What are the applications of OAEs in infants and children?
Cochlear status (does not require participation of infant or child), non-invasive, easy, does not require much preparation, faster to measure than ABR, reliable within and across sessions.
Specific uses of OAEs:
1) Hearing Screening
2) Ototoxic monitoring (noise or drugs)
3) Site of lesion (differential diagnosis)
4) Middle ear status
5) Malingers (psudo-hypocusis, liars)