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117 Cards in this Set

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Components of a hearing aid
Microphone, amplifier, receiver
Types of hearing aids
Body aid: mic and amp on body, receiver at ear level. Good for malformed pinna. Outdated and bulky.
Eyeglass aid: Good for those who want all in one device. Not good if it breaks. Rarely used.
BTE: Good for children because of flexibility with growth, good battery life, good for low dexterity. Bigger, less cosmetically appealing.
ITE: Cover entire concha. Good for size, cosmetics, even though it actually is more visible than BTE.
ITC: Good for size, not good for low dexterity or price.
CIC: Good for size, cosmetics, not good for low dexterity or prices.
Hearing aid batteries
Usually zinc oxide, with voltage from 1.3-1.5 volts.

AA for body aid
675 for BTEs and eyeglass aids
13 for BTEs and ITEs
312 for ITEs
10A for CICs
Used for BTEs to couple aid to ear. Can be made of soft or hard material. Fits the outer ear and ear canal.
Styles of earmolds
Receiver style - used for profound losses
Shell - moderate to profound
Skeleton - mild to severe
Canal - mild to profound

Type and design change acoustics of amplification system.

-Full: fills entire concha
-Half: top half of concha isn't covered

Venting also changes acoustic signal and allow pressure equalization.
Earmold vents
Can provide pressure equalization, acoustic modification, relieve "plugged" sensation, and provide input for unamplified sound.
Hearing aid controls
ON/OFF, Microphone/Telephone/Both (M-T-O), directional switch, volume control, potentiometers (tone control, output limiting)
Telephone switch
Deactivates room microphone and activates inner telecoil, which picks up telephone signal directly through induction. There is also a coil in the handset that leaks magnetic waves to the coil in the hearing aid. Works well with all phones except some cell phones.
Directional microphones
Requires two microphones on the hearing aid. Preference is given to sounds coming from the front. Only available technology that reduces difficulty in hearing in noise.
Programmable hearing aids
Can be programmed with a computer. Not all programmable hearing aids are digital. Very flexible. Some are able to be modified by user.
Implanatable hearing aids
Designed for sensorineural and conductive hearing losses. Tranducer is attached to incus and vibrates the ossicles. Transmitter is attached to skin via magnet or worn as a BTE. Eliminates feedback. Good for users with pinna malformations.

Med-EL Soundbridge is approved for adults with mild to severe SNHL.
Cochlear Corp. Baha (bone anchored hearing aid) for children/adults 5yo+ with permanent conductive HL, mixed HL, or unilateral SNHL
Evaluation prior to hearing aid selection: adults
-Pure tone bone and air conduction
-Word recognition
-Loudness discomfort level testing
Hearing aid evaluation
-Candidacy: high freq. HL that includes 2000 Hz in one or both ears, with difficulty communicating; no medical contraindications; desire to get HA; ENT approval (necessary for children, not for adults)
-Select model
-Ear impression
Choice of HA
Based on cost (usually not covered by insurance), cosmetics, functions, motivation, and medical problems
Hearing aid fitting: adult
Match hearing aid response to loss and measure appropriateness of fit:

-Electroacoustic eval: how is incoming sound modified by HA. Compare individual HA to manufacturer standards. Gain = Output - Input. Full on gain: 60 dB SPL in, VC at max. Frequency response: 60 dB SPL in, VC at standard. OSPL 90: output at VC max and 90 dB in.

-Real ear measures of SPL in canal: REIR = REUR - REAR. Shows what hearing aid is doing.

-Functional gain: aided v. unaided soundfield thresholds. Good for explaining gain to clients.

-Speech perception in noise and quiet
Output limiting
Peak clipping - chopping off the peaks of sine waves to reduce gain to within comfortable limits. Results in square wave-like sound, which creates harmonic distortion.

Compression - compressing the wave to reduce gain to comfortable levels. Eliminates distortion, although it reduces ratio between vowels and consonants.
Counseling and orientation
-Realistic expectations: acclimatization, occlusion effect
-Insertion and removal
-Controls: volume, special circuits
-30-day trial period as mandated by federal law
-Acoustic feedback
-Telephone use
-Warranty and repairs
-Maintenance and accessories
Hearing aid accessories
-Wax loop: used to safely remove wax from HA
-Dri-Aid kit: used as a dehumifier
-Battery tester and spare batteries
-Remote control
-Stethoscope: used by parents/audios to hear the gain of the HA
-Super Seal: water resistant cover for BTEs
-Huggie: loop of plastic to help keep BTEs on infants
Hearing aid fitting: infant
Get accurate diagnosis, select best electroacoustic characteristics, make earmold.

BTEs are best because of flexibility:
-Wide range of gain and output
-Direct audio input
-Need to consider school's needs

Monitor progress regularly, replace earmolds, check for changes in prescription.
New frontiers in technology
1. Open-fit HA
2. Wireless tech
3. New generation of audio rehab
Cochlear implant
-Implantable electronic device that gives access to sound to people with severe-profound SNHL.
-Implantees have had limited success with HA
-Due to their own ears distortion of sound, even if it is audible
-Based on premise that cochlea is site of lesion. Auditory nerve fibers must be intact.
History and design of CI
1. Single-channel devices
2. Multiple-channel devices

Nucleus Device (Cochlear Corp.): 24
Clarion Device (Advances Bionics): 16
MED-EL Device: 24
Parts of CI
-Microphone: picks up sound and converts to electrical energy
-Speech/sound processor: processes electrical signal based on what we know about speech processing
-Transmitter coil: sends electrical signal through head with radio waves
-External magnet: located on transmitter

-Internal magnet: located on receiver
-Receiver: receives radio signal and sends to electrode array
-Electrode array: string of 16-24 electrodes in cochlea. Simulates tonotopic organization of cochlea.
What CI sounds likes
Depends on:
-number of channels
-electrode array insertion depth
CI candidacy
-Audiological evals:
-Medical eval
-Psychological status
CI candidacy: audio evals
FDA requires severe-profound SNHL in children 2yo+ and adults or bilateral profound SNHL for 12mo to 2yo.

-no more than 50% sentence recognition in bad ear
-no more than 60% sentence recognition in good ear or both
-may have pre or post-lingual loss
-pure tone bone/air conduction tests
-speech perception tests: syllable ID, word recog, sentence recog
-testing in auditory mode

Children 2-17:
-lack of progress in auditory skills dev.
-high motivation/realistic expectations from family
-pure tone aid and bone conductions
-otoacoustic emissions
-auditory brainstem response tests
-immitance tests
-speech perception tests: auditory, visual, audiovisual, w/ and w/o sign cues for directions

Children 1-2 years:
-lack of progress in auditory skills dev.
-high motivation/realistic expectations
-no other medical contraindications
CI candidacy: medical evals
-Good general health for surgery
-CT scan
-Vestibular eval
CI candidacy: psych evals
-Adults need realistic expectations
-Provide dev. eval for children to see if there are dev. delays or other disabilities
CI surgery
-Mastoidectomy: string array through middle ear, through cochleostomy, into scala tympani
-1.5 to 4 hours; 1 day in hospital
-Plain film x-ray to ensure correct array insertions
CI hook up
-4-6 weeks post surgery
-Client gets speech processor and external headpiece
-Mapping of frequencies: each electrode in the array is programmed for client at T level and M or C level.

Follow up at weekly/monthly initially, then 6 months/1 year as needed. Test MTS, NU-6 word recog, sentence recog.
CI results: postlingual adults
-Scores around 60-75% correct for conversational speech
-Often use phone independently
-Almost all show increases in speech perception from V only to AV with CI
-Most gains in first 6 months

Most errors are for place, then voicing, then manner.
CI results: prelingual adults
-Much poorer performance
-Some only get minimal benefit and used as supplement to speech reading
-Few have A only understanding of speech
CI results: prelingual children
-Most implanted before 2yo: detect environmental sounds immediately; show closed word set recog of up to 50 words after 4-6 mo; show open-set simple phrase recog at 12 mo

Speech prod. gains:
-using some speech by 4-6 mo post
-increased phonetic/phonemic repertoire

Oral lang. gains:
-lang. age begins to meet chrono age

-Children implanted after 3yo show much slower progress
Factors for successful CI use
-Appropriate mapping
-Regular use of CI
-Good auditory environment
-Family support
-Educational support
-Age on onset of HL
-Early implantation
-Length of auditory deprivation
-Specific intervention for children
Average signal to noise ratio in classroom
-4 dB SNR

Typical noise sources:

Poor acoustics:
Assistive Listening Devices (ALDs)
Devices that improve SNR of a speaker
-Used to minimize effects of classroom or environmental noise
Types of ALDs
-FM systems
-Loop induction systems
-Infrared systems
-Personal or group styles
ALDs: FM systems
-FM Transmitter
-FM Receiver
-Loud speaker/hearing aid/headphones

-Easily used in classroom/public/home
-Appropriate for al ages
-Wireless nature = portable
-Greatly increase SNR
ALDs: Loop induction systems
-Receiver: loop around neck or entire room

Sit inside loop and set HA to t-coil.

-Requires use of HA and t-coil
-Electromagnetic interference is possible
ALDs: Infrared systems
-Used for most TV/public theater
-Output of mic is tranduced to infrared signal and amped to receiver worn by listener

-Must be within range of transmitter
-May not be powerful enough for listeners with severe losses
ALDs: Other
-Telephone amps
-Low-freq. telephone ringers
-Tinnitus maskers
-Signaling devices
ALDs: Tactile aids
-Sound waves converted to electrical signal to vibrator
-Vibrator worn on skin of hand, wrist, chest, thigh, or arm
-Single channel: only fundamental frequency
-Multiple channel: frequency and intensity information
Degree of HL
Normal: 0-20 dB HL
Mild: 26-39 dB HL
Moderate: 40-55 dB HL
Moderately severe: 56-70 dB HL
Severe: 70-90 dB HL
Profound: 90+ dB HL

Some pediatrics cut off normal at 10 dB HL just to be safe.
Describing hearing loss
Degree: how severe
Configuration: frequency range
Type: coming from etiology
Configuration of hearing loss
Configuration: frequency range of loss

-One or both ears?
-Symmetry of loss
*flat: within 10 dB or all frequencies tested have same thresholds
*mild sloping: normal in low frequencies, with worse hearing in higher frequencies. Common with age.
*precipitous sloping: mild-moderate in low frequencies, way worse in high frequencies
*reverse sloping: rare; seen in Leniere's disease
*cookie-bite: seen in kid's with genetic losses; normal-mild in low and high, with curve to higher losses in middle frequencies
*notch: sharp increase in HL in middle frequencies; associated with noise damage
Type of hearing loss
Type: what caused it?

-Sensorineural: damage to cochlea or auditory nerve. Little to no air/bone gap. Usually caused by (viral) infection, trauma, ototoxic meds, or was congenital.

-Conductive: damage to ME or OE. Bone conduction is normal, air conduction is not. Usually caused by trauma, craniofacial anomalies, ear infections, or genetics.

-Mixed: both. Difference in BC and AC should be higher than 10-15 dB. Caused by any of the above.
Onset of HL differences
-Congenital: loss is present at birth
-Noncongenital: loss occurred later
-Adventitious/acquired: loss occurred later
-Genetic: may not occur at birth, ie otosclerosis
-Prenatal: occurred in utero; stroke in utero, STDs, some drugs, maternal rubella
Perinatal: occurred during birth; lack of oxygen, Herpes II
Postnatal: occurred after birth
Prelingual: occurred before learning oral language
Postlingual: occurred after learning oral language. Age range of 3-5 is considered critical, but flexible.
Rehab audio
Focuses on treatment and intervention that is applied following diagnosis of a hearing loss.

May be instrumental (sensory aids) or behavioral (therapy).

Usually focuses on children and the elderly.
Incidence of hearing loss
1:1000 deaf newborns (90% of which are born to hearing families)

4-5:1000 hard of hearing newborns
Role of audiologists
-Provide HA selection and dispensing
-Work with CI recipients (pre-implant evals, hook up, counseling)
-Provide ALDs
-Provide assistive tools
-Test speech perception abilities
-May give communication asses.
-May teach comm. strategies
-Parent/patient counseling
Role of SLPs
-Communication assessment
-Speech language intervention
-Communication strategies
Role of teachers of the deaf/hard of hearing
-Provide educational services in variety of settings
-Works as a team with SLP/audio
-May provide primary language input for children with HL
Role of interpreters
-May be sign language or oral interpreters
-May be mostly in educational settings, but can be elsewhere
Role of physicians
-May have smaller or larger role depending on degree of HL
-Provide referrals for services
Some HL consumer groups
-SHHH: Self-Help for the Hard of Hearing
-NAD: National Association for the Deaf (mostly culturally Deaf)
-A.G. Bell Association: for oral deaf
Acoustic properties of speech
-Segmental component: vowels and consonants. Vowels are longer, with more power/intensity, and more low frequency energy. Consonants are shorter, with less power, and higher frequencies.

-Suprasegmental components: overall frame of speech. Lower frequency characteristics are compared to phonemes; occur over long period of time (timing, syllable structure, pausing).
Acoustic characteristics of speech as derived from speech production
-Vowels: open tract with full vocal fold vibration. Tract changes shape for different vowels. Formant changes as a result, allowing us to hear different vowels.

-Consonants: some part of the tract is either completely or partially occluded. Tract is closed into smaller resonant cavity, creating a higher frequency.

-Suprasegmentals: very slow varition in fundamental frequency.
*Men: 125 Hz
*Women: 220 Hz
*Children: 300-400 Hz
Long-term spectrum of speech (LTASS)
Speech intensity lessens at about 10-12 dB per octave. Less energy in higher frequencies than low, with a peak at about 500 Hz.
Most intense sound
Least intense sound
Why it's important to test for threshold of pain
While the threshold for hearing increases with HL, the threshold of pain decreases. This results in a much smaller dynamic range of hearing. If it's smaller than the dynamic range of speech, you can have problems.
Types of cues
-Spectral: occurs in the frequency domain. Resonances of vocal tract signal cues for vowels as frequency changes over time. Formant transitions are rapid changes in frequency over time in the change from consonant to vowel (or vice versa).
-Temporal: timing change can occur within syllables. Voice onset time can cue voicing, as voiced consonants have shorter onset time than unvoiced. Duration of segments can cue stressed v. unstressed.
Out of place, voice, and manner, which is hardest for people with HL? Why?
Place (spectral cue based on frequency and consonant spectrum), manner (based on duration and temporal envelope), voicing (temporal cue)
Nonsense syllable recognition
-One way to assess speech perception in adults
-Important for analyzing phoneme confusion (using confusion matrix)
-Percent correct: # correct / # total
-Look for error patterns in place, voice, and manner
Vowel confusions
-Confusions occur usually among neighboring vowels because of similar formant values
-May be able to differentiate by duration and intensity (temporal cues)
Consonant confusions
-Configuration of loss relates to type of error
-Degree of loss relates to % correct
-Voicing, manner, place (order of ease)

In /aCa/ where C=b,g,t,m, etc.:
Normal: 99.6% correct
Severe: 50.5% (12.5% = chance)
Profound: 21.1%
Temporal envelope
Envelope around waveform that fluctuates very slowly compared to what goes on inside. Depending on what is inside envelope, it changes its shape. People with HL can pick this up fairly well (/aka/ will have smaller envelope than /ala/).
Coarticulation effects
-Intrinsic vowel duration differences signal final consonant voicing

bid v. bit: bid has longer vowel
bead v. beat: bead has longer vowel
Articulation Index
-Way to identify how much of speech is audible for a listener based on LTASS
-Number from 0-1 (not a %)
-0: none; 1: all
-Speech is divided into 20 bands of equal importance (not size)
-Each band contributes up to .05 toward a perfect AI of 1.0

Affected by:
-Hearing loss: degree and config.
-Noise: depends on circumstances

AI decreases regardless of cause if speech spectrum is unavailable, up until ~60 dB HL when IHC become involved and distortion may be a part.
What's different about hearing loss at ~60 dB HL?
IHC become involved and critical bands widen, causing distortion. Widened bands obscure the location of vowel formants.
Audibility Index
-Approximates Audibility Index
-100 dots in speech area of audiogram, each equal .1
-Value assigned in between 0 and 1 by counting dots available in individual's threshold
-26 dots = .26, suggesting this proportion of speech is audible
Monosyllabic word
One syllable word.

Easiest difficulty on MTS test.
Two syllable word with stress on the first syllable: purple, comfort, crimson, paper, etc.

Most English words have stress on the first syllable. Intermediate difficultly on MTS test.
Two syllable word with equal stress: hotdog, cowboy, popcorn. Most difficult part of MTS test.
MTS Test
Tests monosyllabic, trochee, and spondee words. Important to test speech perception, not just audiogram results. Severe-profound HL shows variability in percentage correct.

Can score for percent or pattern correct. If the mistakes fall within the same category, this suggest there is still good temporal resolution.
GASP = Glendonald Auditory Screening Procedure
1. Phoneme detection
2. Word identification
3. Sentence completion
through monosyllablic words, trochees, spondees, and dactyls (3-syllables).

Gives info on whether listener can pick up patterns (temporal cues) or spectral cues.
ESP = Early Speech Perception Test

Updated version of the GASP that is used more frequently.
Importance of pattern perception
Look at envelope of signal. If similar envelopes, listener with only access to temporal cues will not be able to tell them apart. Can simulate this by filling in signal envelope with white now instead of frequency cues from waveform.

-Intervocalic stops create the clearest acoustic pattern of two sylalbles.
-Intervocalic glides/semivowels create envelopes that look like monosyllables.

Keep this in mind when training clients, as certain words (mama) will not be good to start with.
Oral language continuum v. sign continuum
Oral language:
Oral language -> pidgin sign language -> sign language

Manual signed English/Signed Essential English (1)/Signing Exact English/Rochester Method -> Pidgin signed English -> ASL
Manual codes of English
-Derived from ambient oral language deliberately
-Meant to be used simultaneously with oral language
-Created in 1970s to increase educational performance of deaf children

1. Seeing Essential English
2. Signing Exact English
3. Rochester methods
SEE1 = Seeing Essential English
-Words that sound alike in English have same sign
-English word order
-Signs based on roots and affixes
SEE2 = Signing Exact English
-Words with different meaning have different signs
-English word order
-Signs based on roots and affixes
Rochester method
-All words are spelled in English using fingerspelling
Sign phonology
Called cheremes:
-Tabula (tab): place on body
-Designation (dez): handshape
-Signation (sig): hand movement
-Orientation of hands
Visual modes of communication
1. Cued speech
-If two sounds look alike, they have different handshapes.
-4 hand positions; 8 handshapes
-Supported by oralist, not by signers
-Argued that cuers have better literacy skills

2. Total communication
-Any and all communication that works
-Uses simultaneous communication mostly
-Popular in 1970s (now being replaced by oralism because of CI)

3. Bi-Bi
-ASL learned as first language
-Learn English later through literacy
-Advocated by many Deaf
-Deaf culture

4. Tadoma
-Using hands on face to communicate vibration, jaw movement, and bursts of air to deaf and blind
-Also used for speech production

5. Tactile reception of signs
-Sign into deaf/blind person's hand
-Used more frequently than Tadoma
In audiovisual speech perception, "AV gain" refers to...
The greater than additive benefit individuals receive by combining both auditory and visual cues over either alone.
The incidence of profound HL in newborns in the U.S. is 1:1000. Incidence refers to...
The rate at which new cases of a condition are identified over a given period of time.
Which location of an individual relative to the speaker is optimal for lipreading?
8 feet away and up to 30 degrees off-center
In a closed-set test of auditory speech perception, a listener with a moderate sensorineural HL would most likely confused the word "can" with...
The loudest English phoneme is...
Describe two reasons why children are worse speechreaders:
1. Less joint attention
2. Less able to use context clues because of the limited vocabulary and world experience
Describe how auditory and visual cues provide complementary information about the distinctive features of speech:
What you get from auditory input (place, voice, manner) complements what you don't get from visual (voice, manner).
How hearing aids affect the acoustic properties of the ear
The ear canal provides a boost of energy at ~2500 Hz (higher in children). Plugging up the canal with a hearing aid reduces the energy of the resonant frequency.
What types of assessments are used to monitor and pick an appropriate communication modality for infants?
Auditory, language, and speech assessments
Auditory assessments for infants
1. Aided benefit - real ear measures
2. Functional auditory skills
3. Parent report of auditory skills
Language assessments for infants
1. Prelinguistic skills
-Communicative and Symbolic Behavior Scales
-MacArthur report
2. Parent/child interactions
-See if the parent leads the child or the child leads the parent. Improve relationship as needed.
Speech assessments for infants
1. Babbling
-Observe and quantify babbling: is it canonical, reduplicated, variegated?
-Infants with normal hearing should babble around 6 mo (no later than 11 mo). See how sensory aid affects babbling. If no babbling after amplification, an auditory comm. modality may not be the best choice.
What types of assessments are used to determine if a second handicap exists for infants?
1. Motor skills (fine and gross)
2. Play behavior
3. Social interactions
4. Cognitive abilities

Need to figure out if there is another handicap and which is primary.
What goes into a sensory aid orientation for adults?
1. Make sure they know the full extent of their hearing loss (audiogram, speech results)
2. Insertion and removal of HA
3. Controls
4. Battery testing, replacement, and disposal
What sort of counseling is used with adults?
1. Informational counseling: help patient learn about hearing loss and technology, hoping that they are more willing to do AR
2. Counseling for rational acceptance: help patient manage HL and communication, hoping that they employ comm. strategies and want to do AR
3. Adjustment counseling: help patient work through negative feelings about HL
What assessment techniques are used with adults?
1. Speech perception assessment
2. Communication self assessment
What goes into a speech perception assessment for adults?
1. Auditory
-Syllable recognition (Nonsense Syllable Test)
-Word recognition (NU-6, California Consonant Test)
2. Verbal
-Syllable recognition (for assessing lipreading ability)
-Sentence recognition (CID Everyday Sentences, Denver Quick Test of Lipreading)
3. Audiovisual
-Evaluate speech understanding in noise and use of context clues
-Syllables and words
-Sentences (HINT, SPIN)
What goes into a communication assessment for adults?
1. Self-assessment
-Screening level: SAC, SOAC, HHIE-S
-Assessment level: Used for diagnostic purposes, to help establish goals, and to guide AR
*Intermediate level: Hearing Handicap Scale, Denver Scale of Communicative Function, McCarthy-Alpiner Scale of Hearing Handicap
*Comprehensive level: Gives detailed information across situations and personal perception of disability (Hearing Performance Inventory, Communication Profile for the Hearing Impaired)
*Hearing aid user self report (Profile of Aided Benefit, Abbreviated Profile of Aided Benefit)
What goes into rehabilitation with adults?
1. Communication skills training
-Auditory: conversational style (passive, aggressive, assertive), repair strategies (repeat, rephrase, elaborate, simplify message, indicate topic, message confirmation, write, fingerspell), environmental manipulation
2. Speechreading
-Analytic: used if client scores poorly on syllable-recognition screening. Educates client about visual differences in speech.
-Synthetic: face-to-face training, computer aided training, videotape homework

Expressive repair strategies are used for oral deaf adults to improve intelligibility.
Hearing in Noise Test = HINT
Used to assess sentence perception in an audiovisual way for adults.
Speech Perception in Noise Test = SPIN
Used to assess sentence perception in an audiovisual way for adults.
Uses low and high predictability sentences.

Low: She was glad she had bought ___.
High: The cigarette smoke filled his ___.
Nonsense Syllable Test
Used to assess syllable recognition in an auditory only way for adults.
Used to assess word recognition in an auditory only way for adults.
CID Everyday Sentences
Used to assess sentence recognition in a verbal only way for adults.
Self Assessment of Communication = SAC
-10 item self assessment screening
*communication difficulties in different environments
*feelings about the handicap
*perception of the attitudes of others toward HL
Significant Other Assessment of Communication = SOAC
-Companion assessment to SAC
-10 item screening of same areas
Hearing Handicap Inventory for the Elderly - Screening = HHIE-S
-Used for 65+ clients
-10 questions about emotional and social issues
Hearing Handicap Scale
-Used to assess an intermediate level of self-assessment
-One of the first assessment questionnaires developed
-Focuses on softness/loudness aspects of hearing handicap
-Client rates 20 questions on 5 point scale of almost never -> almost always
*speech perception
*telephone usage
*noise situations

0-20% no handicap
21-40% slight handicap
41-70% moderate handicap
71-100% severe handicap
Denver Scale of Communication Function
-Used to assess the intermediate stage of self-assessment
-25 statements that address
*general communicative experience
McCarthy-Alpiner Scale of Hearing Handicap
-Used to assess the intermediate stage of self-assessment
-34-item questionnaire that address effect of hearing loss on client and SO
Hearing Performance Inventory
-Used to assess comprehensive stage of self-assessment
-One of the first detailed comprehensive tests
-Six sections:
*understanding speech
*response to auditory failures
*occupational (optional)

Shorter 90-item version available.
Communication Profile for the Hearing Impaired = CPHI
-Normed at army base
*communication environment
*communication performance
*communication strategies
*personal adjustment