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128 Cards in this Set

  • Front
  • Back
what is our mode of expressive communication
oral, we use speech. so we are dependent on hearing to receive and perceive the auditory stimuli that makes up speech.
what are we trying to do with auditory training
maximize residual hearing to maximize communication
how do we usually test speech discrimination or recognition
by a list of words, prefaced with a carrie phrase like, "Say the word"

people feel this traditional audiological test doesn't tell how the patients perform in real world conversational interactions.
procedures that may be used to evaluate conversational fluency of a person
interview
questionnaire
daily log
group discussion
structured communication interaction
interview
-gives patient specific information
-difficult to quantify information

patients talk about communication and why they think communication breakdowns occur. gives you an idea about the patients concerns, and their perception of their situation and problems.
questionnaires
-quick and easy to give
-may miss patient specific info
daily log
-gives quantitative info about an extended time period
-can be a reactive procedure

self-monitoring procedure. they answer questions about hteir communication behaviors/strategies/difficulties. this may be a REACTI
group discussion
-stimulates patients to introspect and reflect
-some patients are reluctant to participate

generally a communication strategies training program. everyone list their communication problems & topics and the rest of the program focuses on these issues
the leader must get everyone to participate & help guide the discussions
structured communication interaction
-has good face validity because assessment is based on actual conversation interactions
-can be time consuming to score

these are simulated convo's that reflect communication difficulties that occur in a day. they discuss the problems and alternative ways to handle the problems.
conversational fluency can be evaluated with consideration of (1) # of prolonged pauses (2) # of restarts (3) # of topic shifts (4) interruptions of turn-taking (5) level of abstraction and superficially (6) presence of self-consciouness (7) degree of understanding.
which procedure to evaluate the conversational fluency may be reactive
daily logs
they may influence person's communication behaviors and how they use communication strategies
the communication model
oral communication originates with a purpose to engage in communication, land properly encode and articulate that which needs to be conveyed or "the message"
what is the message
meaningful linguistic units of auditory stimuli, in addition to the auditory stimuli, there are also visual cues
feedback mechanism
where the auditory system of the speaker makes it possible to be sure of the accuracy of the intended message
what is the communication situation
the environment, it has competing background noise and degrades the amount and quality of the communication that is able to be conducted
the receiver or listener must be able to...
receive, decode, and interpret the intended thought
communication model brom Alpiner
4 levels of concern
1. Message expression
2. Message encoding
3. message decoding
4. message perception

message is sent to a person (listener), it is encoded by auditory-visual & tactile systems, it is related to environment of the individual as a social, vocational, or emotional need, and is perceived by the receiver
message expression
a communication event is trnsmitted through sound, touch and movement. it must transcendenviornmental barriers to reach the receiver. Barriers may include phone lines with static, rooms with high background noise, etc.
message encoding
the individual must be able to receive the communication. the integrity of the receivers auditory, tactile, and visual systems must be intact to receive the message being sent
message decoding
when the message reaches the receiver, it must be interpreted. this may be determined by internal cognitive factors and by social, vocational, and emotional needs of the individual
message perception
the receiver of the communication internalizes the message, may ask for clarification, may observe the speakers feedback, and may repair the perceived meaning of the message before formulating a response
what affects out ability to communicate
- Perception of segmental (individual speech sounds) components
- perception of suprasegmental (rate, rhythm, intonation) components
- intensity, frequency, and duration of components of speech
- transitional cues
when is the ear developed
early in the first trimester

we hear speech over other environmental noises
the ear can process signals of
about 140 dB
in 1953, Fletcher reported that
connected speech at about 1 meter from the speaker is about 65 dBspl ======45 HL
what is the difference between SPL and HL
20 dB
20 dBHLSPL =
0 dBHL
a shout will be about
85 dBSPL =65 dBHL
very soft speech will be about
45 dBSPL = 25 dBHL
do individual phonemes have different energies
yes, there may be anywhere from 28-56 dB differences between the softest and loudest sound depending on the variability of intensity of individual voices
the normal ear can perceive auditory stimuli between
20-20,000Hz
the normal ear can hear sounds with an intensity of
up to 130-140dB
what will influence the intensity levels of a situation
the distance between listener and speaker
what is stronger vowels or consonants
vowels
do hearing impaired often get the vowels or consonants
vowels, because they are louder
whos voice is greater in intensity males or females
males, about 3 dB higher
frequency parameters of speech
the overall spectrum of speech has acoustical energy from 50-10,000Hz with the greatest amount of energy below 1000Hz
male frequency
female frequency
child frequency
130 Hz
260 Hz
450 Hz
vowels are _____ and ______ frequency and contain __________
low
mid
most of the power of speech
each peak amplitude is known as a
formant
consonants have a ...
broader high frequency spectral composition than vowels. especially the voiceless ones
voiced consonants usually have ______________ and voiceless consonants usually have ____________
more low and mid frequency energy

more mid and high frequencies
what did ling find to be the most important suprasegmental cues of speech
intonation, rhythm, pitch and stress
the duration of individual sounds covers a range from
30-300 msec
what are longer vowels or consonants
vowels
vowels average ____ msec
130-360
consonants average ____ msec
20-150
transitional cues
when phonemes are connected in speech, each acoustic property of the phoneme alters slightly to allow the movements of articulators to produce the next sound.

transitional cues are the acoustic byproduct of this process
speech perception/comprehension
made up of the following components
1. detection (affected by hearing acuity)
2. discrimination (ability to distinguish speech stimuli)
3. identification (ability to identify what was heard)
4. attention (degree of attention affects speech perception)
5. memory (storage of verbal information for brief periods)
6. closure (speech elements brought together into meaningful whole)
what adds to the redundancy of communication
topic, situation, references, facial expressions, gestures etc
true/false
conversational speech is highly redundant
true
what can reduce the redundancy of communication
noise, the amount of information present that allows us to understand speech

ex; poor articulation of the speaker, improper inflection, poor lighting, environmental distraction, reverberation, inability to identify the topic of the message, poor listening skills, ;ack of familiarity with the rules of the language
so what must we do to help the HI
help them utilize their residual hearing to the fullest capacity, regardless of amplification device or lack thereof
we must maximize communication by developing the auditory sensory system to the fullest. this will allow us to...
-maximize receptive communication
-acquire more proficient speech and language
-educational advancement
-vocational advancement
-better psychosocial adjustment
why do we engage in conversation
many reasons such as sharing ideas, relating experiences, telling stories, expressing needs, instructing, influencing etc.
rules of conversation
implicit rules that guide our conduct in conversation
what are the rules of conversation
-tactily agree to share one another's interests
-ensure that no single person does all the talking
-participate in choosing what to talk about and participate in topic development
-take turns in an orderly fashion
-try to be relevant to the topic of conversation
-provide enough information to convey a message without being verbose
when should the rules of conversation be modified
when the individual has a hearing loss
regarding the rules of conversation, what should you do/expect when speaking with someone who has a hL
-expect more interruption for clarification
-try to ensure the other can contribute to topic development
-realize lack of relevancy may be due to misunderstanding
-modify speaking style to be slower with more precise articulation
what should be done pre and post training
assess the auditory skills

assessment during training will let you know how you are progessing
what will the assessment of the auditory skills allow
1. determination if auditory training is needed
2. provide a comparison for outcome measures (has expected benefit been achieved)
3. key in on specific areas of perception which need more help
4. Compare different listening devices
5 roles during early speech acquisition of auditory information
1. Auditory information potentiates the development of specific principles of articulatory organization. If you can’t hear and self monitor, then you may not manage breath streams for speech, articulate properly, more smoothly and continuously from one articulatory posture to the next.
2. By listening to others, children learn how to produce specific speech events. So it becomes harder to produce the different sounds when they cannot be heard.
3. Children develop a system of phonological performance. If you can’t hear, you can’t acquire some sounds, especially those associated with high frequency auditory information like “s”, “t”, “sh”, etc.
4. Auditory feedback informs children about the consequences of their articulatory gestures, and how these consequences compare to sounds produced by other talkers. Deaf kids can’t tell if a plosive sound is inappropriately loud and so it is common for a deaf person to produce a slight popping sound during production.
5. Auditory feedback may provide information for monitoring ongoing speech production and for detecting errors. So deaf talkers can’t monitor themselves for proper production. i.e. if you say “see went” you will correct to “she went” but a deaf person cannot do this.
some studies say_________
vowel error types include
the tongue is not moved correctly and there is more reliance on jaw displacement

- neutralizations
- substitutions
- dipthonizations
- prolongations
- nasalizations
what are characteristic consonantal errors
- voiced/voiceless confusions
- substitutions
- omissions, distortions
- errors in consonant clusters.
Speech quality of the severe to profoundly HI is also distinctive. There are errors of:
- stress (equal stress or inappropriate stress)
- speaking rate (speak very slowly with lots of pauses and prolongations of sounds)
- coarticulation (each sound may be articulated as individual units)
- breath control (few syllables per breath, inefficient airflow management)
- voice quality (pitch may be high or variation, some speak with a monotone)
- intensity (may speak too softly or too loudly or intensity may fluctuate inappropriately:
carhart
anything he did was long and an involved procedure
people have gotten away from using it
insurance doesnt pay
SKI-HI
1985-Clark and Watkins
developed a comprehensive identification and home intervention treatment program for infants and their families

This method gives practical activities to reach objectives set out for the parent and the child in each lesson.

it has 4 phases
SKI-HI phase 1
(4 – 7 mo)
a. attending
b. early vocalizing
SKI-HI Phase II
(5 – 16 mo)
a. recognizing
b. locating
c. vocalizing with inflection (intensity and pitch)
SKI-HI Phase III
9 – 14 mo)
a. hearing at distances and levels
b. producing some vowels and consonants
SKI-HI 4. Phase IV
(12 – 18 mo)

a. environmental discrimination & comprehension
b. vocal discrimination & comprehension
c. speech sound discrimination & comprehension
d. speech
Foundation in Speech Perception
1994, Interactive software system for eval/dev of listening skill in hearing impaired kids, whether they used aids, tactaid, or CI.
1. Use of non-speech and speech stimuli to develop fundamental auditory skills.
2. Incorporation of spoken and written connected language in the form of stories.

Each lesson may be tailored to meet a particular child’s own perceptual level.
Consonant Recognition Training
1981
1. relies on the analytic approach to facilitate improved speech perception
2. is a combined auditory-visual approach
3. incorporates speech reading
Communication Training/Therapy
1. focuses on improving an individual’s perceptual skills through focused exercises and drills
2. emphasis on sharing information of relevance regarding the communication process.
3. what the individual can to do assist in facilitating conversational understanding
communication Strategies Training:


important
a. anticipatory – anticipate and prevent
b. facilitative – influence talker, structure of message, the environment
c. repair – provide instruction about what to do following a communication breakdown (when one person says something and the other does not recognize the message – i.e. repeat the message in different words)
Facilitative Communication Strategies:
1.Strategies that influence the talker
a. instructional strategies (don’t cover your mouth, slow down)
2. Strategies that influence the message
a. message-tailoring strategies – give limited choice for answering (what did you do last night? Vs did you stay home or go to the movies?)
3. Strategies that influence the environment
a. constructive strategies to enhance communication environment (move to a quieter room for conversation)
4. Strategies that influence the patient’s reception of the message
a. adaptive strategies: include relaxation technique and
other ways to deal with emotions and negative
behaviors due to hearing loss
b. attending strategies: consciously relax, attend to
taker’s lip movements, try to decrease anxiety to enhance message recognition
c. anticipatory strategies: prepare to a communication interaction. Anticipate potential vocabulary and conversation as for a job interview
what type of repair strategies are there
receptive repair strategies
and
expressive repair strategies
receptive repair strategies
repeat repair strategy – ask to repeat
i. nonspecific repeat repair – “huh” “what?”, “pardon”
b. request for information repair strategy
c. key word repair strategy
d. elaborate repair strategy
e. extended repair strategy – when many repair strategies
are needed to solve the communication breakdown.
expressive repair strategies
repeat original message with keywords emphasized and
slow down to best articulation
b. break longer sentences into shorter sentences
c. use another communication modality such as writing or mime, using hand gestures as in pointing
so in terms of repairing communication we must
A. detect communication breakdown
B. choose course of action, whether it be:
i. use repair strategy (receptive or expressive)
ii. disregard utterance
we must keep the individual in mind when developing plans...
a. assess the individual in terms of his/her current status, wants, problems, and needs. It is not just the hearing status.
b. Develop a broad strategy based on a consideration of the current needs and the individual’s willingness to comply. Be flexible however as needs may change over time.
c. And as you implement your plan, tailored to that particular individual, be prepared to change if something proves unsuccessful, deal with new problems as they arise.
what are the 2 service delivery models
medical model
Rehabilitation Model
medical model
a. top down communication
b. authoritarian
c. clinician determines dx and tx of clients’ conditions
d. clinician does something “to” clients
e. appropriate and necessary in acute emergency situations
f. assumes clinician knows what’s right and best for clients
g. oriented toward disease and pathology

doctor is the ruler
Rehabilitation Model
a. horizontal communication
b. interactive, facilitative
c. clinician helps clients identify and resolve clients’ problems
d. clinician does something “with” clients
e. ideal for chronic conditions and preventive measures requiring adherence to tx regimen
f. assumes clients’ perceptions and needs will decide treatment goals and strategies
g. oriented toward self-actualization, adjustment, and well-being
WATCH
– Montgomery: 1994
A one hour introduction to aural rehab
W: Watch - lipreading
A: Ask - conversation repair strategies
T: Talk - admit to the hearing loss
C: Change situation – take control
H: Health-Care Knowledge (education- awareness)
while we rely on hearing in conversation, we also look at the speaker for:
 mouth movements
 facial expressions
 gestures
 the surrounding physical environment & this may include attire
Variables affecting speechreading may fall into one of 4 areas
what are they
a) The Speaker
b) The Signal Code
c) The Environment
d) The Speechreader
a) The Speaker
-There is a positive correlation between speaker-listener familiarity & improved information reception
-Facial expressions & gestures contribute to ease of speechreading.
-Positioning of speaker to listener also contributes to speechreading ability. -Avoidance of smoking, chewing, or yawning is also helpful.
-For males, a bushy mustache or mustache/beard may confound the listeners ability to speechread as well as will placing the hand over the mouth.
b) The Signal Code
The basic unit of speech is the phoneme and each has distinctive acoustic features to identify it. Vowels have the major concentration of acoustic energy and are called resonated phonemes. They are created by changes in the oral cavity. Consonants are called articulated phonemes as the articulators are involved (lips, tongue, teeth). Much of the 40 phonemes used in English have limited visible features. Thus one might rely on consonant-vowel combinations to read speech. In connected speech, all we see is lots of movement & if there is no pause, it’s like reading a sentence without spaces between the words. But the redundancy of English comes into play now. Based on context (topical constraints), situational cues, appropriate vocabulary for the topic, & grammatical structure, we limit our choices, thus making it easier to predict the missed information.
c) The Environment
-Distance & viewing angles between the speaker & listener may affect speechreading performance. (Erber found 5 ft to be optimal and greater than 20 ft to be significantly detrimental.)
- Environmental cues may provide the listener with contextual & situational information, improving the ability to predict the correct information.
-appropriate lighting is needed in order to see.
d) The Speechreader
these may limit the speechreader’s abilities:
Auditory Sensitivity & Perception
Age
Intelligence:
Personality Traits
Visual Skills
Age
the elderly may do poorer due to inability to process abstract stimuli and decreased
Intelligence
best if at least average intelligence. Some educational abilities affect here as well. Better versing in grammatical structures help limit expected phonemes.
Personality Traits
motivated individuals are usually more effective speechreaders but much of the ability may be innate.
Visual Skills
Good visual acuity is important. Those with a high number of blinks do not do as well as those who blink less. Distance has an effect on visual acuity and even a minor reduction of visual acuity can be detrimental.
Auditory Sensitivity & Perception:
Included in this category are age at onset of HL, progressivity, site of lesion, level of education, familiarity with the language & its grammar
There are those who evaluate speechreading ability to:
a. determine if visual communication training is warranted
b. to evaluate the effectiveness of speechreading trainin
formal speech reading test
may presented in
b. vision only
c. combined visual-auditory
d. via tape or live voice
e. in different manners
Informal Speechreading Tests:
a. clinician develops their own
b. may use different speech forms like words or sentences
SPEECHREADING METHODS
1. Analytic
2. Synthetic
Analytic
It is necessary to perceive each part of a word or sentence in order to identify it, identify individual words or phonemes before perceiving sentences
2. Synthetic
Perception of the whole is paramount, comprehend the general meaning
why are there few speechreading strategies for children
because of the fact that most approaches try to maximize the auditory channel with little attempt at improving speechreading skills.
This is an auditory only approach
auditory-verbal approach.

for children
The auditory only approach used for children
holistic approach for children
suggested by Yoshinaga-Itano focuses on each child’s motivation, tolerance, sense of responsibility for communication and builds on that knowledge base and develop appreciations that are all client oriented, using what is needed by that individual and what they are capable of. Therapy based on each child’s capabilities and needs. Activities must be interesting and activities must give opportunity to experience success. The bisensory stimulation approach is favored.
what is vision important for
speech reading and manual communicaiton
types of manual communication
1. American Sign Language
2. Pidgin Sign Language
3. Signed English:
4. Seeing Essential English (SEE I): signs based on word roots present; not popular or common
5. Signing Exact English (SEE II)
6. Linguistics of Visual English (LOVE)
7. Fingerspelling
8. Cued Speech
American Sign Language
st form of manual communication; known as ASL; some signs may be visual ipages of the English word (iconic signs) Said to be the 4th most commonly used language in the United States.
Pidgin Sign Language
combines ASL with English, modifies ASL; used in conjuction with speech
Signed English
Words are in the same order as spoken English & have suffixes to indicate tense, person, plurality, and possession.
Signing Exact English (SEE II)
Now used to the exclusion of SEE I; signs are word based, signed in strict accordance with English
6. Linguistics of Visual English (LOVE):
7. Fingerspelling
8. Cued Speech
Same as SEE II but has a method of writing each sign
Fingerspelling
manual representation of the written language
Cued Speech
uses handcues, 4 hand positions and 8 handshapes near the mouth to accompany vowels and consonants to supplement visual information.
what has ASL also been known as
Ameslan
Manual Codes of English
signing systems (not languages) that utilize the manual component of a signed (read: nonverbal) language to convey the grammatical and syntactical structure of spoken English. They do not share the grammatical and syntactical structure of American Sign Language.
types of MCE tried :
signed english (SE)
Seeing essential english (formally SEE1)
Signing Exact English, or, formerly ‘SEE2’
Linguistics of Visual English (LOVE)
The Rochester Method
Signing Exact English, or, formerly ‘SEE2’
SEE2 is very similar to SEE1, however:
1. compound words are conceptually accurate (‘butterfly,’ not ‘butter’+ ‘fly’)
2. more ASL signs (one sounded word = one sign) are used
3. there are at least seventy artificial/invented signs and affixes added to this system
SEE2 was developed in 1972 by Gerilee Gustason; SEE2 is currently the “signed English” that is used in American school systems. (This is the ‘Signing Exact English‘ referred to below.)
Linguistics of Visual English (LOVE)
A. was a chirography system based on Seeing Essential English modes; it used the Stokoe Notation System (tab-dez-sig) to codify sentence structure.
b. Unfortunately, there is very little explanation and/or examples extant of the LOVE system.
c. LOVE was developed in 1972 by Dennis Wampler
The Rochester Method
A) called this because it was developed in 1878 by Zenas Westervelt, a teacher at the Western New York Institute for Deaf-Mutes (later Rochester School for the Deaf)
B) every word is fingerspelled.
C) Sometimes used in tactile signing situations, some Deaf adults still use this method.
Seeing Essential English, or, formerly ‘SEE1’
Intended to reinforce basic English morphemic structure, in SEE1:
1. compound words are formed with separate signs (‘butter’+‘fly’)
2. the same sign is used for homonyms (‘bear’ and ‘bare’)
3. there is a heavy use of initialization (haVe)
4. affixes, articles, and ‘to be’ verb were added
SEE1 was developed in 1966 by David Anthony at Gallaudet College. SEE1 is no longer in use today.
Signed English (SE)
a) Signed English is a simplified English-based code
b) SE only added fourteen grammatical markers.
c) developed in the mid-1970s by Harry Bornstein at Gallaudet College,
Signing Exact English
a. a system of signing that strives to be an exact representation of English
where does signing Exact English take much of its vocabulary from
from American Sign Language (ASL)

but modifies the handshapes used in the ASL signs in order to incorporate the handshape used for the first letter of the English word that the SEE sign is meant to represent
where is Signing Exact English used most often
with Deaf children in educational settings
what was the initial goal of SEE
to facilitate the learning of English, but it is easier to learn for people who have already learned english
Cued Speech
manual system which, when produced near the mouth while speaking, helps the Deaf disambiguate the phonemes in spoken language.
Cued speech combines
eight arbitrary handshapes and four locations to visually and phonetically approximate the sounds of English.
is cued speech a signed language
no, it is a visual means of representing spoken language segments