SLHS 1150: FINAL EXAM
218 Cards in this Set
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Sound can be described in the following ways
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• Physical: Frequency, intensity, duration
• Psychological: Pitch, loudness
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Duration of the sound
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• Sound travels at 1116 ft/sec
• Takes 10ms for sound to reach the brain
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Pitch
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Frequency of the sound
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What is the minimum frequency all sounds have
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At least 1
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What frequency can humans hear?
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20-20,000 Hz
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What determines how high a pitch is?
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Number of different areas of compression and rarefaction (less areas = lower sound)
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Do we hear all frequencies at the same loudness
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No, humans can't hear high frequencies very well
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Intensity of the sound
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How loud/intense do we perceive the sound
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How do we measure intensity of sound?
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Decibels (expressed dB SPL--> sound pressure level)
-Allows us to capture the wealth of sound in 140 units
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Decibel (dB)
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o Logarithmic scale
o Expressed as a ration of measure pressure to a known reference pressure
o 0 dB is NOT SILENT
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What is an Audiogram?
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• A measurement of hearing in each of our ears across freq.
• Ear-specific freq.-specific info
• Tells us the person's thresholds at a particular freq.
• Visual representation of person's thresholds at given frequencies and intensities
• The audiogram gives a good picture of what a pe…
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What is a Threshold?
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• The lowest sound you can hear 50% of the time
• Thresholds very
o Day to day
o Based on alertness, mood, diet
o Thresholds vary from freq. to freq.
*As people age, thresholds get worse
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Frequency ranges
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• Mild hearing loss (25-39 dB HL)
• Moderate (40-54 dB HL)
• Moderately severe (55-69 dB HL)
• Severe (70-89 dB HL)
• Profound (90+ dB HL, kind of dangerous)
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Mild hearing loss (25-39 dB HL)
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Difficulty in background noise; sounds muffled
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Moderate (40-54 dB HL)
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A little difficulty in quiet; soft sounds/ends of words gone
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Moderately severe (55-69 dB HL)
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Miss a lot of conversation speech
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Severe (70-89 dB HL)
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Can't hear doorbell, telephone ring; no conversation
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Profound (90+ dB HL, kind of dangerous)
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May not hear fire engines, smoke detectors
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Minimum audibility curve
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• Humans don't perceive all freq. at the same loudness
• The threshold for different freq. is at diff dB SPL
• dB SPL and dB HL are different
• Audiograms are measured in dB HL
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The MAC and dB HL
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• Humans are most sensitive to freq. where most speech is
• To make an audiogram look normal, dB HL are used
• dB HL and dB SPL are not the same
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Do humans hear all frequencies at the same intensity?
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No
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What frequencies do humans hear best?
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2000 Hz-5000 Hz (frequencies of speech)
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Auditory assessments
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-Behavioral assessments
-Objective assessments
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Basic equipment for auditory assessments
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• Audiometer or portable audiometer
• Otoscope
• Transducer (headphones)
• Different equipment for different parts of the auditory sys.
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Audiological testing
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1. Screening
a. Quick check of performance
b. Provides a broad view
c. Less time consuming
d. Relatively inexpensive
e. Does not need to be performed by highly qualified professional
2. Comprehensive evaluation
a. Looks at skill in an in-depth manner
b. Needs to be performed by …
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The ingredients to a comprehensive auditory evaluation
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1. Case history
2. Otoscopy (instrumentation)
3. Pure-tone audiometry (behavioral assessment)
-Air and bone
4. Speech audiometry (normal formal test)
5. Additional testing PRN
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Audiometry
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-Air Conduction
-Bone Conduction
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Bone conduction
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Reflects the function of the cochlea, regardless of the status of the outer or middle ears
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Air conduction
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Provides an assessment of the functional integrity of the outer, middle, and inner ears
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Case history
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• Identify patient's perception of problems
• Identify patient's pertinent medical history
• Any possible causes of hearing loss
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What's Otoscopy?
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• Otoscope
o Lighted magnifying device to inspect the outer and middle ear
o Identifies problems in the outer and sometimes middle ear
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Pure-tone audiometry
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• A behavioral test
o Air conduction thresholds
o Bone conduction thresholds
o Speech testing
• Why do we do it?
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Speech audiometry: What's the purpose of speech testing?
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• Gives different info than pure-tone audiometry
• Easier to test with children than pure-tone audiometry
• Tells us how an auditory problem may impact communicative problems of daily living
• To estimate communicative function
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Aspects of speech audiometry
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Speech recognition threshold (SRT)
-Baseball, hotdog, playground
Speech awareness threshold
-Picture pointing task
Word or sentence testing
-"say the word ball. Say the word dog."
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Audiogram
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visual representation of what someone's hearing loss looks like; visual representation of a person's thresholds at given freq. and intensities
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Objective testing
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1. Tympanometry
2. Acoustic reflexes
3. Otoacoustic
4. Electrophysiology
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Typmanometry
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• Tympanograms
• Test used to detect disorders of the middle ear
• Air pressure in the ear canal is varied to test the condition and mobility (movement) of the tympanic membrane (ear drum)
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OAEs
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• Objective measure of inner ear function
• A machine that listens for sounds that the cochlea makes in response to sound
• Discovered by David Kemp in 70s (didn't get credence till late 80s)
• Present otoacoustic emissions are a good sign of functioning hearing. Absent OAEs indicate a…
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Electrophysiology tests
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• ABR- Auditory Brainstem Response*
• ASSR
• N1P2
• MLR- Middle Latency Response
• ALR
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3 kinds of hearing loss
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1. Conductive
2. Sensorineural
3. Retrocochlear
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Conductive hearing loss
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-Problems with the outer middle ear
-Problem is getting signals to the cochlea
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Sensorineural hearing loss
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-Problems within the cochlea, specifically with the hair cells
-Problem is in the auditory nerve
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Retrocochlear hearing loss
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• Problems beyond the cochlea
i. Auditory nerve
ii. CANS
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Central processing/central deafness
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Problem is in the brainstem or brain
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What is normal hearing for adults and children?
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-Adults 0-24 dB HL
-Children 0-14 dB HL
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Why is normal hearing different for children?
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'Pristine' hearing key for acquisition of speech and language
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fetuses
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• Begin to hear around 26 weeks in utero
• By birth:
-Recognize langauges similar to theirs
-Recognize their voice
• Auditory sys. Not full developed by birth
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Milestones in infant hearing
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• Birth-3months
-Startles to loud sounds
-Wakes to noise
-Recognizes your voice and gets quiet when heard
• 3-6months
-Turns eyes to an interesting sound
-Appears to listen
-Awakens easily to sounds
• 6-12months
-Turns head towards sounds
-Understands a few words
-Begins to imi…
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Hearing loss in infants
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• Incidence
o 3 in 1000 infant are born with a hearing loss
• A hearing loss in infants is defined as thresholds at any frequency above 15 dB
• At a great risk for speech and language disorders
*infants need prestine hearing to acquire lang., more important than adult hearing
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EHDI: early hearing detection and intervention
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• Goal: to identify and provide intervention for babies with HL as early as possible in order to maximize likelihood of normal development of speech and language
• Detection
o Newborn hearing screenings
• ABR: Auditory brainstem response
• OAE: Otoacoustic Emissions
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Newborn hearing screenings
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no national law for universal hearing screenings; some people choose to have home births, aren't screened when theyre born. (6 states don't have a law)
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Etiology of hearing loss
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Congenital or acquired
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Congenital hearing loss
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-Born with it
60% of hearing loss at birth is genetic
• syndromes (50%)
• Mutations (10%)
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Acquired hearing loss
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40% of hearing loss is acquired
• Anoxia
• Ototoxic drugs
• post-natal infections
• ear infections
• Perforation of TM (tympanic membrane → cant get sound to his cochlea easily→ conductive hearing loss)
• Noise exposure
• Head injury
• Disease
o Meniere's disease
o Otosclerosis
…
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Non-congenital hearing loss in babies
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• If it's not genetic is could be
o Prenatal infection
o Toxemia in pregnancy
o Anoxia (oxygen deprivation→ cochlea uses oxygen)
o Related to prematurity
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Etiologies of hearing loss in children/adolescences
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• Outer
-Malformation of structures
-Perforation of ear drum
-Tympanosclerosis
• Middle
-Malformation
-Otitis Media
• Inner
-Sensorineural
-Malformation
• Central
-Central auditory processing disorder
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Otitis media
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• Ear infection of the middle ear
• 75% of children have had OM by age 3
• 75-95% of children will have experience OM by age 9
• More common in males
• More common in winter and spring because those are the season kids get the most colds which can start OM
*Process
-Eustachian tube …
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Why do kids get more ear infections
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• Eustachian tube is smaller and more horizontal in children
• Poor fluid drainage from middle ear
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Behavior signs of OM
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• Inattentiveness
• Wanting tv louder
• Misunderstanding directions
• Unexplained irritability
• Pulling or scratching at ears
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Central auditory processing disorders
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• Have normal hearing in peripheral sys
• Auditory perceptual problems as a result of impaired central auditory nervous sys.
-Sound localization
-Auditory discrimination
-Pattern recognition
-Hearing with background noise
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What are two important questions to ponder when we think of treating a hearing loss?
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1. What kind of hearing loss?
2. How severe of a hearing loss?
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1. What kind of hearing loss?
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Conductive Hearing Loss vs. Sensorineural Hearing Loss
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Conductive Hearing Loss
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• Problem lies in getting sound to the cochlea
• Surgery for conductive losses
o Surgical repair of the affected part of the auditory sys.
• Anotia
• Ossicular Malformation
• Stapendectomy
o Cochlear implantation
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PORP/TORP
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o Partial/total ossicular chain replacement prosthesis
o Goal is to improve hearing and speech
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Stependectomy
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o The problem: Otosclerosis
o The solution: Stapendectomy
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Sensorineural Hearing Loss: Damage within the cochlea
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o Problem is within the cochlea or auditory nerve
o Dead hair cells
o Cochlear malformation
o Meniere's disease
o The signal can not be properly conducted electrically
*We can't cure SNHL but can work to alleviate SNHL
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What is Aural Rehabilitation?
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o The process of assessing, diagnosing, and treating a hearing loss.
o The ultimate goal: functional communication for the person with hearing loss
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What are some methods of providing aural rehabilitation?
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o Environmental modification
o Counseling
o Amplification
o Speech reading
o Communication strategies
o Auditory training
o Microphones
o Listening strategies
o Alternative communication (ASL)
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Environmental Modification
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Problem: Noise
-Noise makes it hard to hear for everyone
Issues:
o Distance
o Noise
o Reverberation
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Signal to noise ratio
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The higher the signal to noise ratio, the better you are at listening
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Things you can do to ensure a good communicative environment
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o Move the conversation
o Put down carpeting and curtains
o Take out loud machines
o Make sure there's visual access
o Pre-teaching
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Lip or Speech Reading
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The use of:
o Facial expressions
o Gestures
o AND what you see on the speaker's lips
To help you understand
o Benefit from visual cues
o Problem is with visemes (11 of them)
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Auditory Training
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o Brains are plastic, can change
o Neuroplasticity→ we get better at things we practice
o For some people, auditory training over time works
o Could be synthetic
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Repair strategies
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The problem: communication breakdown
o Not receiving the message
o When model is interrupted, a communication breakdown occurs
How to handle them
o Detect communication breakdown
o Choose course of action
o Disregard utterance, bluff, or use repair strategy
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How do we repair?
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• Specific request ("could you say that in a different way, I didn't hear that")
• Non-specific request ("What", "Huh")
• Confirm ("I just want to make sure I heard that correctly")
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How do they repair?
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o Repeat
o Paraphrase
o Elaborate
o Confirm (confirms only go with confirms)
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What makes an Assisted listening devices (ALD) an ALD?
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• Microphone
• Digital processing chip
• Speaker to make it louder
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Benefits to ALD's
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• Provide a boost to hearing for cheap
• Provides benefit in mild to moderate losses
• No FDA regulation
-This means you can go out and buy one today!
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Limitations to ALD's
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• Almost always linear programming (always going to make it that much louder→ problem if the sound is already loud)
• Little to no signal processing (they aren't doing anything to the sound like a hearing aid or cochlear implant would do)
• Nothing to couple sounds to the ear (hearing a…
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Hearing aids: Amplification options
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• Amplification makes sounds louder, so that they are audible for someone with hearing loss
-Air conduction (most hearing aids are these)
-Bone conduction
-Body worn
-Eye-glass model
-Behind the ear
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What is a hearing aid?
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-FDA controlled medical device
-Machine that amplifies sound for wearer
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Is hearing aid uptake increasing over time?
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No
• One of the few problems that people don't treat
• 1 in 4 people treat their hearing loss
• The reason why is likely multifactorial:
-Price
-Limited perception of benefit
-"I hear what I want to hear"
-Cosmetic concern
-Not worth the effort to get fit with a hearing aid
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What are the key parts to a hearing aid?
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• Microphone
• Processor
• Receiver
• Battery
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Types of hearing aids
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• BTE: Behind the ear
• ITE: In the ear
• ITC: in the canal
• Bone conduction aids
• Extended wear HA
• RITE: Receiver in the ear/canal
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What is a hearing aid doing?
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Features
• Programming
o Multi. Microphone input
o Compression
• Algorithms
o Noise reduction
o Music (enhances)
o Makes speak as audible as possible
• Volume control
• Connectivity (w/ iPhone, etc)
o FM
o Induction
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Dynamic range of hearing aids
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Dynamic range: the range of volumes that we normally hear
• 0-100 dB (range of most people)
• Lowest sound they can hear to the loudest sound they can tolerate
* People with hearing loss have reduced dynamic range (40-100 dB)
• Hearing aids used to be linear, now they utilize compress…
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What is a cochlear implant?
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• Implanted into the side of the head, wire stringed through the middle ear space into the cochlea and spiral it up as far as we can
• Electrical device that creates hearing sensation by directly, electrically stimulating the auditory nerve
• A Cl bypasses the severely damaged hair cell…
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What are the important parts of a cochlear implant?
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• Electrode array
• Speech processor
• Microphone
• Head-piece
• Implant
-Converts sound into electrical impulses, through the skin to a magnet that transmits the impulses into the snail shell (cochlea)
*Higher you go, the lower the frequency
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What are the candidacy requirements for adult CI users?
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Children
• Age 12 moths or older
• Bilateral profound sensorineural hearing loss for children under 2 yrs of age
• Limited benefit with appropriately fit hearing aids
• No physical contraindications for placement of the implant (i.e. CT scan results)
• Medically cleared to undergo su…
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Contraindications to Cl
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• Hearing loss of neural or central origin
-Auditory neuropathy
• Absence of a cochlear or auditory nerve
• Active middle ear infections
*Contribute to the downfall of ASL
*22 "keys" to try to get the same message across
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Who is the best candidate for a cochlear implant?
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• Post-lingually deafened individuals (already learned the language they speak)
• Deafness of a short duration
• Highly motivated with a strong support sys.
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Process of cochlear implantation
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• Discovery of hearing loss
• Trial with amplification
• Evaluation of candidacy
• Implantation
• 'Turning on' of implant
-How long after surgery? 4-6 weeks after
• Multiple follow up visits for tuning
-Retrain the brain
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What do Cl's sound like?
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Doesn't sound anything remotely to what you think→ cochlear implants are not like hearing aids
o Hearing aids amplify sound
o Cl's provide an electrical signal instead of an acoustic signal
-The actual sound depends on the # of channels in the electrode array
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Limitations to Cl
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o It's head surgery, and general anesthesia is necessary
o Little known about long term effects
o It's expensive- $45,000 to $75,000
o Medical issues
o MRI, meningitis
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Takeaway of Cls
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o Hearing sys. Is still very much impaired, person will never hear 'normally'
o Success varies hugely with cochlear implants
o Open-set v closed-set
o Deaf cult. Issues
o Controversy
o Removal of implant (cant get wet, MRIs, etc.)
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What is a head injury?
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-Any injury to the head
-Trauma that leads to injury of scalp, skull, and/or brain.
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What is a traumatic brain injury (TBI)?
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-Skin or bone injuries of the head count as this
-Brain damage due to impact of external forces
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Incidence (TBI)
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a. 1.5 million TBI's per yr.
i. 50,000 resulting in death
b. 85,000 long-term survivors of TBI
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Most at risk (TBI)
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a. Men, lower SES
b. Also infants and seniors over the age of 65 (both suck at balance)
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Causes of TBI
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a. Falls
b. Motor vehicle accidents
c. Assaults
d. Recreational/occupational accidents
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TBI: open vs. closed
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Open-head injury (OHI)
a. Skull & meninges penetrated
b. Phineas Gage
c. Often seen in combat
Closed-head injury (CHI)
a. More common
b. Skull and meninges intact but brain jostled
c. MVAs, falls, physical assault, abuse
*OHI-frontal lobe damage→ personality changes
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Social recovery hypothesis
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a. Recovery takes a long time
b. It takes a highly structured environment
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Process of TBI
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a. TBI is a process, not an event
b. Secondary injury can be more damaging than the primary injury
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Brain contusion
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a. Defined by cell death accompanied by hemorrhage.
b. The soft brain tissue is vulnerable.
c. Contusion can occur distant from the point of impact.
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Increased intracranial pressure
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*What kills people in TBI
a. The volume of the intracranial vault
i. 80% brain
ii. 10% blood
iii. 10% cerebrospinal fluid
b. Problems:
i. Edema
ii. Excess blood
iii. Excess cerebrospinal fluid
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Diffuse axonal injury
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*Causes the most brain damage
a. Occurs in up to ½ of traumatic brain injuries
b. It's diffuse, damage is widespread
c. Involves the shearing of axons in the white matter tracts
d. Major cause of persistive vegetative state
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Stroke
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*Result of brain injury and surgery
a. Ischemia stroke
i. Caused by decreased oxygen delivery to the brain tissue
ii. Occurs in trauma secondary to swelling
b. Hemorrhagic stroke
i. Caused by decreased oxygen delivery die to blood leaking
ii. Occurs as both primary and secondary inj…
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Focal vs. Diffuse damage
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a. Focal damage
i. Ex. Contusion
b. Diffuse damage
i. Anoxia, coup-contrecoup injuries
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Deficits of a head injury
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a. Physical
b. Behavioral
c. Mental/cognitive
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Impairments of attention
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a. Definition: Ability to focus on stimulus
b. Internal (pulse, song stuck in head) and external (airplanes, construction) distractions
c. Difficulties in:
i. Communicative comprehension
ii. Tangential conversation
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Impairments of behavior
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a. Frontal
i. Emotion control
ii. Inhibition
b. Temporal
i. Difficulty in learning
ii. Persistent talking
c. Parietal
i. Increase of clumsiness and neglect
d. Occipital
i. Vision difficulties
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Impairments of memory
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a. The ability to retain and learn info
b. Amnesia
i. Retrograde and anterograde
ii. "50 First Dates"
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Impairments of speech and language (TBI)
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a. Cognitive-communicative impairments
i. Deficits in thinking skills can disrupt communication skills
b. Aphasia
i. Depends on location of focal lesion
c. Pragmatics
i. Conversation, tone of voice, facial expressions, gestures, emotional expression
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SLP role in TBI
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Interdisciplinary team
-The slp is going to work with a lot of people in dealing with patients w/ TBI
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Assessment of a TBI
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a. Objective notations
ii. Loss of consciousness
iii. Duration
iv. Post-traumatic amnesia
v. Persistent symptoms
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Tests for TBI
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1. Early
a. Standardized tests
i. Glasgow coma scale
ii. Rancho los amigos (LOCF)
2. Later
a. Brief test of head injury
b. Info processing assessment
c. Dysphasia ...
*Solution to memory problems: technology
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Standardized tests for TBI
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Glasgow coma scale
-TBI: head trauma associated with a Glasgow coma score of < or equal to 8
Rancho los amigos (LOCF)
a. Responsiveness to stimuli
b. Ability to follow commands
c. Cooperation
d. Confusion
e. Attention to the environment
f. Focus
g. Coherence of verbalization
h…
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Later tests for TBI
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a. Brief test of head injury
b. Info processing assessment
c. Dysphasia ...
-Rancho levels VII-X
• Goal is to facilitate independence
• Re-mastering the pragmatic communicative competence
• Applying communication skills to the environment
o Community outings
o Increasingly indepen…
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Solution to memory problems
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Technology
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Concussions
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a. A concussion is a brain injury
b. Trauma-induced alteration in mental status
c. Diffuse
d. Results from jostling brain in the skull
e. Trauma from impact or sudden movement change
*need AT LEAST one week to recover
-Blast injuries and concussions
-Dementia pugilistica
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Dementia pugilistica
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Brain damage caused by cumulative and repetitive head trauma
Treatment:
-Similar course of Alzheimers
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Outer ear
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-Pinna
-EAM
-Tympanic membrane
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What does the auditory sys. change signals into that travel through the air?
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• Into a mechanical signal
• Into a hydraulic signal
• Into an electrical signal
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What are the purposes of the outer ear?
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1. Channels sound energy to the tympanic membrane
2. Amplifies certain frequencies (speech frequencies, frequencies we use to communicate with each other)
3. Protects tympanic membrane from harm
4. Helps us localize sound using the pinna
*converts acoustic energy into mechanic…
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Pinna
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Part we consider the ear (cartilage portion). Protects your ear, amplifies frequencies, 2 pinnae help to localize sound
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EAM
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(External Auditory Meatus) 2-3 cm long, lateral ½ is cartilage, medial 2/3 is bone, S shaped (part flesh, part bone); enhances certain frequencies
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Tympanic membrane
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(Eardrum) 3 layers of skin, 2 areas (pars flaccida, pars tempa→ vibrations). Vibrates in reaction to sound waves striking the surface; surface bows slightly inward.
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Impedance
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Energy bounces off of water in the cochlea. Impedance allows us to get past this. (The biggest problem we have in hearing is impedance. The auditory sys [esp. middle ear] I especially designed to overcome impedance)
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Middle ear
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-Connect ear drum to cochlea
-Air filled space; houses the ossicular chain; 2 windows into the cochlea→ middle ear connected to the sinus by Eustachian tubes
-Ossicular Chain
-Eustachian Tube
-Windows (Round and oval windows)
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What is the purpose of the Middle ear?
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• Changes acoustical energy into mechanical energy
• Overcomes impedance mismatch
-Via area ration
-Via lever action; 20:1
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Windows
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-Oval window
-Round window
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Round window
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Provides a place for pressure relief in the hydraulic sys.
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Oval window
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Provides a point of entry fro the stapes to push in.
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Eustachian Tube
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Air-filled tube
• Connects middle ear to the nasopharynx
• Regulates/equalizes pressure
o Opening the tube causes pressure to be equalized
o You open your tubes (at least once a min. while youre awake and once every 5 min asleep)
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Ossicular Chain
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Malleus, incus, stapes; smallest bones in the body; connect eardrum to the cochlea.
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Inner Ear
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Cochlea
Basilar membrane
Hair cells
Organ of Corti
Auditory nerve
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Basilar membrane
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• Is tonotopically organized
• Is about 35mm long
• High sounds vibrate at the basal (bottom)*
• Low sounds vibrate the apical (top)*
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Cochlea
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• Fluid filled cavity
• Bony cave filled with membranes
• Houses the Organ of Corti
• Very small (4mm)
• Converts hydraulic signal to electrical signal
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Hair cells
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Inner and outer hair cells
• 3 outer hair cell rows
• 1 inner hair cell row
• Receive both afferent and efferent innervation
• Code for diff. signals
• Afferent innervation creates a signal for the auditory nerve
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Organ of corti
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a structure in the cochlea of the inner ear that produces nerve impulses in response to sound vibrations.
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Auditory nerve
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bundle of nerve fibers that carries hearing information between the cochlea and the brain.
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What is the purpose of the inner ear?
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The semicircular canals:
-Serve as the body's balance organ
The cochlea:
-Serves as the body's microphone, converting sound pressure impulses from the outer ear into electrical impulses which are passed on to the brain via the auditory nerve.
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The Central Auditory Nervous System
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-Brain stem
-Heschyl's Gyrus
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Tonotopic organization
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• Exists in
o Cochlea
o Auditory nerve
o Brain stem
o Auditory cortex
*Not middle or outer ear
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Brain stem
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• Takes the electrical input from the auditory nerve
• Channels signal through series of stations
• Further and further processing on the way up to the auditory cortex
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Heschyl's Gyrus
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a convolution of the temporal lobe that is the cortical center for hearing and runs obliquely outward and forward from the posterior part of the lateral sulcus
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What is the purpose of the Central Auditory System?
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The sensory system for the sense of hearing.
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Impairment
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Loss or abnormality of psychological or anatomical function (ex. Have no legs, won't be able to walk in a provincial manner)
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What is the WHO ICF model
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Impairment
Disability
Handicap
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Disability
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Restriction of lack of ability to perform an activity (Result of the impairment. Example from above→ can't walk because they have no legs)
ex. Cannot hear or see
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Handicap
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Disadvantage (having trouble filling some kind of role) that limits or prevents fulfillment of a role
ex. cannot drive, cannot play bingo
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Complex Communication Needs
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Sender→Communication method→ Receiver
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What does it mean to have complex communication needs?
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Static Communication Impairments
o An intervention that facilitates language and literacy development for young children w/ communication disorders
o Facilitated primarily by the SLP
o For people with Complex Communication needs
Ex. Alternative communication: ASL (sign language)
-2 m…
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Effective communication
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Multimodal
o Spoken
o Facial expressions
o Vocalizations
o Voice inflections
o Gesture
o Eye gaze
*Speech, language, motor or cognitive impairments that prevent an individual from communicating in conventional ways
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What is an AAC device?
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Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves.
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Components of an AAC device
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Symbol: Representation of an idea or concept
a. Acoustic
i. Morse code, words
b. Graphic
i. Written word, picture, semaphore
c. Manual
i. Sign language, cued speech
d. Tactile
i. Physically manipulated things
2. Aid: Device used to augment communication
a. Word boards
b. Dyna…
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What is the overall goal of an AAC assessment?
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o Goal:
o Identify, measure, and describe
• Factors affecting communication
• Effects of communication impairment on daily life activities
• What facilitates communication?
• An AAC sys. That would enhance communication and participation
a. What is communication like now?
b. What…
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AAC and literacy development
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o Literacy skills are critical for CCN children
o Because speech and writing are presented atypically, the literacy process is different
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Strategies for people who communicate with AAC
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a. Non digital
i. Ask what yes means
ii. Ask what no means
iii. Ask if it's OK to finish words/guess
iv. Repeat the word after they point to it
v. Tell them when you get lost
b. Digital
i. Ask what yes/no means
ii. Wait till they finish
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Disability in the U.S
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o Pre-1900
• Perception of disability has changed over the years
➢ Disability as sin / abomination
➢ Disability as witchcraft / magic
➢ Disability as an object of pity / tragedy
➢ Disability as stigma
o Mansfield Training School- epileptic patients who seizures could not be controll…
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Improvements in disability in U.S?
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o Stigmatized, but the disabilities were more known about
o Protections for Disability / Advocacy
• The aforementioned acts provided focus and protection for people with physical disabilities
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"Treatments for disability"
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• Frontal lobotomy- scoops out your consciousness but worked for
• Forced sterilization- so they cannot have any children ever- WAS widely excepted
• These were widely excepted treatments- was it better? Yes but also no
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Modern disability
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o Disability as social identity
o Wealth of legal protections
• ADA, IDEA, Section 504, etc.
o Technology can accommodate many disabilities
o Recognition of both mental and physical disabilities
o Much more nowadays- cultural identity that people have deaf community, identify as havi…
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Disability in Communication Disorders
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• WHO-ICF
• World Health Organization = WHO
• Handicap, Disability, and Impairment
Know the model that we learned last time- sending, etc
A model for Disability
• Impairment
o Loss or abnormality of psychological or anatomical function
• Disability
o Restriction or lack of ability…
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Disabling Speech
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• 7.5 million people in the US live with a voice disorder
• 3 million Americans stutter
• 6-8 million people in the US have some form of language issue
• Disabling Hearing Loss
o For adults aged
• 45-54: 2%
• 55-64: 8.5%
• 65-74: 25%
• 75+: 50%
• Identify as having a hearing loss…
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Modern laws
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o Section 504 (1972 rehabilitation act)
o first federal civil rights protection for people with disabilities
o Anything at the federal level, from housing to federal employment
o Cant deny someone housing for a disability, cant deny someone employment because of a disability
• ADA- 19…
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Aural habilitation options
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• Hearing aids
• Cochlear implants
• Both (bimodal)
• Neither
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Language options
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• ASL
• English
• Cued speech
*need exposure to a language
*needs to learn how to read in order to be successful in life
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Education option
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• Mainstream public school
• Private school
• Deaf school
*Education was key
• Education of the deaf requires more effort than education of the hearing
• Loss of resilience in SNR (Signal to Noise Ratio)
• Use of the visual modality
• Development of literacy
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ASL
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• Manual language-language that done through your hands
• Markers
o 5 parameters (hand shape, location, motion, orientation, facial expression)
• Different syntax
-ASL only works in the U.S and some parts of Canada
-Closer etymologically to French than British
-No established writte…
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ASL etiquette
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• Don't stare
• Look at faces, not hands
• Don't be offended by bluntness
• If you need to get through, just walk in between signers. Don't dillydally
With an interpreter?
o Talk to the person, not to the interpreter
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What is the difference between someone who cant see vs. someone who cant hear?
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o Process of learning to communicate is much more effortful for hearing impaired
o Deaf people need someone to facilitate if they choose to go to college
o Someone who cant hear is someone who is more socially isolated because they cant communicate with their peers
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Pidgin communication sys. Arises out of necessity
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communication was either "pidgin" based or non-existent
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American School for the Deaf
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(1817- 1st school for the Deaf in North America)
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Oralism vs. Manualism
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• Difference in educational philosophies
o Manualism: communication should be in the visual modality
o Oralism: Communication should be in the oral modality
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Schools for the deaf
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• Arrived after 1825
• Every state had one
• Exploded in popularity in the 1900s
• Residential program
• A have for sign language and Deaf culture
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Deaf clubs
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• The adult equivalent of the School for the Deaf
• A place where deaf culture is primary
• Sign language only
• Community events
*around 1940, the debate between oralism and manualism started
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Deafness in 1990s
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• Outbreak of German measles
• Large number of children born deaf
• Deaf schools filled to capacity
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Deaf President NOW movement
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• 1988 president search committee
• Pivotal moment of Deaf as a minority group
• Media exposure of Deaf culture
• Shift in educational expectations
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Deaf (other info)
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• Deaf (use sign language, identify with Deaf culture) vs. deaf (you have a hearing loss)
• Deaf (culturally Deaf) vs. Hearing culture
• Cochlear implants→ ASL use is on the decline, deaf culture is dying out
• Schools for the Deaf (decline in enrollment, bad epidemic of deaf children…
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Aphasia
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An acquired disturbance in the language system
Umbrella disorder many different kinds of aphasia
-Broca's
-Wernicke's
-Global
-Anomic
-Transcortical
-Etc.
*Something wrong with expressive or receptive language
-After language has been established
-The result of neurological i…
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Vascularization of the brain
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Brain uses a lot of oxygen (more oxygen per capita than any other part of the body)
-deprive any part of brain oxygen, kill that part of the brain
Arteries provide blood flow and oxygen for brain
Most aphasias are the result of very specific, very localized damage or a stroke
-dep…
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Common Causes of Aphasia
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Traumatic Brain Injury (Contusion in the language areas of the brain)
Brain Tumor
Stroke
-Cerebrovascular accident (CVA)
Ischemic Stroke (blood clot)
-Thrombotic Episode
-Embolism
Hemorrhagic Stroke (blood is everyone but the pipe you need it to be in)
*higher up the better (m…
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How can we describe aphasia?
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Receptive vs. expressive
Fluent vs. Non-fluent aphasia
Fluency: speaking easily and effortlessly
*Non fluent: receptive or expressive skill is such that fluency is effected (cant get the words out- cant speak)
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Non-fluent aphasia
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Broca's (expressive non fluent)
Transcortical motor
Global
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Fluent aphasia
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Wernicke's (receptive fluent don't understand what's being said to you)
Transcortical sensory
Conduction
Anomic
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Aphasia: prognosis
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Prognosis is extremely important for aphasia
Influenced by:
-Site of lesion
-Size of lesion
-Severity of aphasia
-Handedness
-Age
-Pre-injury health
-Motivation for treatment
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Aphasia: recovery
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-To some degree, almost all patients will recover without intervention.
-The Brain rewires itself.
-Plasticity of the brain
-Therapy provide interventions that would improve patients better than they would do on their own
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Aphasia: treatment
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*Should shoot to increase recovery beyond that which spontaneous recovery would achieve.
Drills working on:
-Motor planning
-Motor execution
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How much noise is too much?
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Noise is a combination of:
-Duration
-Intensity
Damage occurs at a high enough intensity
Damage occurs with sufficient duration
If you increase intensity, you decrease the time you can withstand before damage
(How loud the sound gets and how long you have to hear it. Higher t…
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When should someone wear hearing protection at work?
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When the noise exceeds 85 dB
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OSHA
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-Occupational saftey and health administration
-In charge of ensuring noise management in the work place
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CHAOC
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-Council for accredidation in Occupational Hearing Conservation
-In charge of standards for hearing screening, occupational noise exposure measurement, and prevention
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The Vestibular Organ
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2 organs (left and right) consisting of:
1 Utricle - Horizontal plane
1 Saccule - Verticle Plane
3 Semicircular Canal - Rotaional
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Sense of balance
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Vision
The vestibular system
Proproceptive senses
Peripheral Senses
Feeding into the brain for processing
-Cerebellum
-Cortex level processing
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Peripheral Senses
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Vestibular organ
Ocular input
Proprioceptive system (sense of touch telling you what youre in contact with)
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Vestibular Assessment
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Screen - The Romberg Test
Subjective Questionnaire
Vestibular Testing
*Assesment is whatever makes the eyes move
Nystagmography
Caloric testing
Rotary Chair Testing
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Gestalt processing
|
The ability of the brain to form meaningful perceptions in a chaotic world
Usually facilitated by the right hemisphere of the brain
Especially present in vision and sound
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Motor Speech Disorder
|
• Speech production deficit resulting from a problem in speech motor control
• Deficit in speech, not language
• Other oral movements (eating, facial emotion) can co-occur
• Usually an issue in between the brain and the cranial nerves
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Speech Motor Control: Muscles must coordinate
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o Breathing
o Voicing
o Appropriate "shunting" of sound
o Coordination of the articulators
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Speech Motor Control: Prevalence and Incidence
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• Incidence is unknown/complicated
o In 2008, 148,000 diagnoses of motor speech disorder
o Dependent on what's causing the problem
• Prevalence
o MSD composes 51% acquired communication disorders
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Speech Motor Control: Etiology
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• Brain injury
o Stroke, traumatic brain injury, Anoxia, Cerebral Palsy
• Progressive Neurological Disorders
o Parkinson's, ALS, Huntington's Disease, MS
• MSD are called either Developmental or Acquired
Apraxia of Speech
• Motor planning/Programming disorder
o Difficulty grouping…
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Dysarthria
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• Motor Execution Disorder
o Physiological deficit and abnormal movement of muscles
o Can be both Acquired or Developmental
• Looks like: slurred, slow, quiet, or uneven speech
• Often caused by: Progressive Disease and Trauma
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Assessment of MSD
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The Assessment focuses on
• Perceptual Measures → Speech Sample (Systematic Observation)
• Acoustic Measures → Spectrograms (Instrumentation)
• Physiologic Measures → Myogenic potentials (Instrumentation)
• Looking at the subsystems of speech
o Respiration, phonation, resonation, art…
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Treatment of MSD
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Treatment goal
• To learn or relearn the motor aspect of production
o Acquisition
o Retention
o Generalization
o 80% - if he patient does something 80% of the time during session, will probably do it most of the time in the real world
Treatment Methods
• Slowing rate of speech
…
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Oral language
|
A person's expressive and receptive language ability
Phonological, grammatical, lexical, discourse
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Phonological awareness
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A child's understanding of the sound units of oral language
Strongest predictor of children's reading outcomes
Dog = /d/ + /a/ + /g/
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Print awareness
|
A person's understanding of the form and function of written language
Typically develops a continuum,
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Alphabet awareness
|
The knowledge of the letters that make up the alphabet
Begins before the age of 2, mastery by 5
Begins with the letters in their name; A, B, C
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The Alphabetic Principle
|
The concept that speech and print correspond to each other in a predictable fashion
A = ah; E = eee; F = ph
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Decoding
|
the application of the alphabetic principle to the written word
|
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Reading Comprehension
|
drawing meaning from the text and constructing meaning based on prior knowledge and experience
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Initial Reading & Decoding
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5-7 years old; decoding of letters/sounds
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Confirmation & Fluency
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7-8 years; reinforcement of words, and mastery of high-frequency words
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Reading to learn
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9-14 years; reading leaves egocentricity
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Reading from multiple viewpoints
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14-18 years; continuation of learning, students can take multiple view-points into account
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Reading in a world view
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18+; analysis, synthesis, and prediction
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Assessment and Intervention of Literacy Disorders
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1. Referral - patient referred because of concerns that reading is a challenge
2. Designing an Assessment
There is a specific area of concern usually
Customize an assessment
Many methods: chart review, interview, systematic observation, questionnaire, formal test, instrumentation (not…
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SLHS 1150: QUIZ 2