*in sessions speechreading is often prevented in the clinic room.
What is total communication?
philosophy of communicating with children who are deaf using on or several modes of communication.
*including, oral lanuage, signed communication, written language, fingerspelling, gestures, facial expression and cued speech depending on the child's needs.
What are some goals of total communication? (children)
Building the child's knowledge base concerning the speechreading process.
develop an appreciation of benefits that speechreading can provide in perceiving speech.
stimuli is based on each client's capabilities and needs in real like situations.
clinical activities address the individual needs of each child.
What is the goal of total communication in adults?
To highlihght the benefits of using the visual skills that a patient already has in order to maximize speech perception abilities
What are 4 quick tips for speechreading?
1) be relatively clost to the speaker
2) watch the speaker's mouth, facial expressions and hand gestures
3) maximize your hearing with hearing aids and ALD's
4) let the talker know you have a hearing loss.
What are the 4 identigying physical characteristics of ASL?
What are some highlights of ASL?
There is not a corresponding sign to represent each english word.
ASL is NOT a form of English, but is a distinct language produced manually that requires just as unique a translation of English as does any foreign language.
What is SEE?
Manually coded English, often used in educational setting to minimize the differences that exisit between spoken and written English and ASL.
A system in which English words that appear in a message seigned in that same order.
What is fingerspelling?
Manual communication where the sender spells the words with their fingers.
speakers spell their message in the air by using handshapes to represent letters in the English alphabet
*aka the manual alphabet
T/F Fingerspelling is the most efficient form of manual communication
False, due to the rapidity of "spelling" a message, reception requires considerable practice and concentration.
*used as supplement, to express proper names, technical terms and events that cannot be conveyed by signs.
Study of minimal units of language that are meaningul.
Study of sound systems used in language.
Functional use of language.
study of word meanings and word relations.
Governs the rules of how words are arranged in sentences.
What are the hearing loss effects on spoken language?
1)deteriorated speech signal (person will miss out on parts of form, content, and use)
2)Leads to delay in language
What are some factors that will affect hearing acquisition?
1) degree of loss
2) age of onset/ age of intervention
3)presence of other disabilities. (may have other disabilities that trump HL therapy)
What percentage of children with hearing loss have other special needs?
What are some predicting factors of early expressive language development?
Age of identification (hearing loss)
Presence of additional disabilities
*sidenote: the greater the hearing loss, the greater the expected language delay!
What are 3 key factors that impact S&L outcomes?
Increased patient diversity (eng not 1st lang)
Availability of cochlear implants (remember, sev->prof loss)
If early identified at how many months will the child be most likely to catch up to their normal hearing peers?
before 24 months.
When trying to acheive early intervention what are the predictors of speech intelligibility?
More advanced language development.
Lesser degree of hearing loss.
Oral mode of communication.
What are the factors of cochlear implant use on language acquisition?
Age of implantation (EARLIER the better)
Amount of intervention
Severity/progression of HL
T/F Implanted children still have a less thatn optimum acoustic signal that creates language, listening and academic difficulties.
Mothers of deaf chidren are less likely to use.... and more likely to use..
Less likely to use:
-Ask for opinions
-Ask for suggestions
More likely to use:
-Give more suggestions
What are language characteristics of preschool H.O.H.?
Hearing loss during the critical period of development may deprive the chid of unambiguous auditory and linguistic cues from language models.
Lack of an auditory signal may severly compromise development of semantic,syntactic, mophologic, pragmatic and phonologic aspects.
Increased chance for reading and academic difficulties.
What are the other forms of communication parents of deaf may use more of?
Tactile attention-getting stategies
What is a schema? and why is it important?
It is considered the language processing and planning that is developed through
Early language development is established through use of daily routines in the child's life.
How is knowledge of Schema in preschool children in normal hearing children different from those of HI?
Children with normal hearing will hear parents talk during dinner, bath or bed time as well as over hear parents talking in other occasions.
HI children may have limited access to the language their family is using daily.
Also HI children may hear little conversations unless it is directed toward him or her.
What are the semantic and pragmatic functions in H.O.H preschool children?
Children with HI exhibit a full range of pragmatic functions, but limited semantic functions using nonverbal and verbal communication.
If a HI child is identified by 6 months and has normal cognitive function will have vocabulary similar to...
Children with normal hearing
What are the three major aspects of language evaluated in the language of H.O.H. school age children? (>2)
What is the lexical-semantic skills of school age H.O.H. children?
May very from a mild to profound delay
Reduced vocab is common with HL
Sever delays in the acquisition of lexical-semantic skills were ovserved across all age groups from 5-20
What is the syntactic-morphologic skills of school age H.O.H children?
Delay in lexical-semantic skills will aslo transfer into a delay of syntactic-morph skills.
Restricted knowledge of word classes (nouns/verb usage)
Restricted knowlede of syntax
Deviant syntax with profound HI (word order, word endings, omission of major sentece constituents)
What is the pragmatic kills of school age H.O.H children?
Many children with HL have difficulties with conversational turntaking, topic initiations and maintenance.
*Sidenote: these skills progress as they get older, but are developed at a slower rate depending on age of ID and age of intervention.
What are the debates of plateau in language acquistion?
Moeller found little growth in semantic and syntactic skills with severe HL after 12-13
On the other hand Yoshinaga-Itano warns that language growth does occur after 12
What are some preliteracy and literacy issues of school age H.O.H children?
In reference to reading and writing they may not have the exposure that normal hearing peers have.
Phonological awareness may be a precursor to reading ability and is defined as the ability to recognize that words consist of individual syllable and phonemes.
*Sidenote: Prelingual deafness may inhibit phonemic awareness this is possibly due to limited exposure.
What are the 3 categories of measures used for assessing the language of children with hearing impairment?
1) Communication checklists
2) Formal language tests
3) Communicating/language sample analysis
*Sidenote: few measures of language are specifically designed for those children with HI. Do not compute or use mental ages or IQ scores because results only show language delay.
Why are printed tests a disadvantage to those that are HI?
The test may reflect their reading abilities rather than their language abilities.
What are ways to provide optimal environment for evaluation?
First a listening/function of check of hearing aids/CIs should be performed before any evaluation.
Reduce niose and distractions
When giving oral instructions/materials, allow the child ull access to speechreading skills.
*sidenote: the clinician needs to be proficient in the child's primary means of communication.
What are the treatment goals for language development of deaf children? (Carney and Moeller's)
1) Enhanced parent communication
2) Understanding of increasingly complex concepts and discourse
3) Acquisition of lexical and word knowledge.
4) Development of verbal reasoning skills.
5) Enhanced self-expression.
6) Development of narrative skills.
What is important about communication/language management?
The goal is exposure to the child's everyday communication functions.
Therapy should include facilitation of a wide range of everyday events and reasons and how to communicate about them it should not be solely direct language targets and forms.
What are strategies for developing conversational skills?
1) encourage the child to practice as a conversation to partner learning how to initiate, take turns and end conversations.
2) Use of recasting: when child uses incomplete or inappropriate forms during conversation, the adult rexasts the utterance mantaining the child's meaning, but providing the appropriate form.
What is a good way to create an opputunity for the child to communicate in routine situations?
To get a child to use their pragmatic skills saboteur strategies may be used.
These provide the child opportunities to use language that has been mastered
*Ex: stand in front of them to elicit them to ask you to move.
Before what age is it most important to get an AABR done?
By what age can a baby discriminate sounds?
T/F Normal hearing children vocalize in an unordered sequence from birth to 1st words.
False, they follow a sequenced order.
What are the difference in sequence order of vocalization?
Similar to hearing they coo, goo and babble.
They tend to produce a greater proportion of velar back consonants at 12-15 mos.
Fewer consonant-like sounds from 6-10 mos.
Redup'd babbling around 11-25 mos with fewer instances than normal hearing babies.
What is speech intelligibility and how do you evaluate?
Proportion fo speech understood by the listener.
Eval involves recording the H.O.H. individ and then further evaluating word ID and overall intelligibility.
What are some factors that influence the scoring of intelligibility?
1) Experience of the listener with deaf speech.
2) Difficulty level of the vocabulary and sentence structure for the speaker.
Who is most likely to rate deaf speech with an intelligible?
An experienced listener of deaf speech.
What are the affects of speech intelligibility on perception of the HI?
Effects daily conversation and others perceptions of a speaker's cognitive copetence and personality.
*Sidenote: those with at least moderatly good intellig are perceived much more positively than spkrs with poor intellig.
The _____ of HL is directly related to te intelligibility of the person.
T/F children using oral communication models have better intelligibility.
True this is because they have...
- more intensive speech training
- teacher in TC did not have expertise in speech training
- higher expectations set by teachers and parents
- peer use of speech
What are two key areas for speech concerns of those with HL?
-Advancements in hearing aid/Ci technology provides greater access to speech acoustic cues than every before.
-Speech training must be centered on overall communicative competence.
What are the 6 guidelines for achieving the areas of speech concerns? (prelingual)
1) integrate auditory and speech goals
2) follow a "dialogue" rather than "tutorial" format
3) use bridging activities to promote real world carryover
4)practice communication sabotage
5) usecontrasts inperception and production
6)select speech goals that enhance communicative competence
What is considered mild-mod sev and sev-prof ranges? (prelingual)
Mild-mod sev<70 dB HL
Sev-prof >70 dB HL
What are mild-mod sev speech characteristics? (prelingual)
Errors: misarticulation of single consonants and consonant blends (mostly high freq)
Due to the usual sloping hearing loss config, most errors for speech sounds are
2) high freq
3) short duration
Mild to moderatly severe loss errors are of what manner and which type? (prelingual)
Affricatives, fricatives and blends
Substitutions, distortions and omissions
What are some areas not important for assessment of mild-mod sev? (prelingual)
What should therapy be aimed toward in mild to mod sev speech management? (prelingual)
articulation and/or phonological treatement
What should be considered during treatment of mild to mod sev speech management? (prelingual)
1) Use of visual and tactile cues to aid in speeh distinction
2)Familiarity with the child's aided thresholds to ID the speech sounds that are in the child's audible range
3) awareness of the impact of co-articulation, due to the change of soundsas the are paired with different speech sounds
What are speech characteristics of sev to prof range? (prelingual)
Average intellig for this type of HL is approx 20%
What are the characteristics of respiration for persons with sev to prof HL? (prelingual)
May speak only a few syllables on a single exhalation of air
What are the resonance characteristics of those with sev to prof HL? (prelingual)
Resonance: the vibration of air in the throat and oral cavity and/or nasal cavity
- problems include hypernasality and hyponasality
*Sidenote: nasality is found in the lower freq's
What are the characteristics of phonation of sev to prof HL? (prelingual)
Vowel prod's may invovle inadequate vocal fold adduction
breathy voice quality
perception of substituting vless and v or make vless into high freq v'd sounds
decr control of fund freq
varied speech intensity
What are some vowel error patterns of sev to prof HL? (prelingual)
1) vowel neutralization
2) diphthong and vowel confusion (ex: /aI/ for /a/
3) nasalization of vowels
What are some consonant error patterns of sev to prof HL? (prelingual)
Omission and distortion of consonants (velar and final consonants)
Omission of consonants in blends (top for stop)
Nasalization of consonants
What is palatometry?
Device fit to the patients palate and contains 96 electrodes for recording tongue to palate placement
*sidenote: children with prof Hloss have idiosyncratic tongue to palate contacts
What is a suprasegmental aspect?
Important because they communicate an indivuidual's emotional intent, urgency of message and linguistic stress which includes changes in duration, intensity and fundamental freq scross syllables in an utterance.
Those with sev to prof Hloss speak at an overall rate of ___ to ___ times slower than speakers with normal hearing.
Speech assessment of sev to prof HL should include...
Measures of intelligibility, articulation and phonology, suprasegmental features and voice characteristics
When measuring speech intellig of sev to prof some variables inclulde?
1) complexity of vocab and sentences spoken
2) presence/absence of contextual cues
3) presence/absence of visual and speechreading cues
4) listener experience with deaf speech
What is some aspects of articulatory and phonology measures of speech intelligibility of the sev and prof HL?
Test are not normed of children with hearing loss but do give accurate measures to incorrect pronunciation.
They may imitate or produce a large number of speech sounds but do not use them correctly to produce words in ongoing speech.
What did Ling suggest to record for an evaluation of discourse?
conversation, description, narration, question and explanation.
T/F There is an extreme variability in error patterns among individuals.
What are four approaches to enhance speech training for sev to prof HL?
1) early and consistent use of hearing to optimize residual hearing.
2) anatomic and pictorial monitoring
3) visual cues
4) use of complex feeback aids
It is important to ______ the use of residual hearing for speech management.
What is the use of pictorial and anatomic monitoring of speech management of those with sev-prof HL?
Anatomic charts, saggital sections of the head with mobile articlators and pictures of the tongue shape
*sidenote: pictures are less favorable de to the lack of movement
What is the use of visual stimulation for speech management of sev to prog HL?
Usually involves a mirror to see visual feedback
*sidenote: this should be limited as visual contexts of sounds change as function of context (shoe looks different that she [sh])
Describe the complex feedback of speech management for sev to prof HL.
Uses devices to provide visual monitoring of acoustic features of speech
*sidenote: used primarily as a supplement in a treatment plan
Postlingual profound loss producesa gradual ______ of speech.
What are specific speech errors of postlingual profound HL?
Decr vowl space due to centralization of the first two formants
inaccurate production of /s/ and /sh/ (high freq)
similar voice onset time values for v'd and vless plosives
subs of /r/ and /w/
tendency to omit consonants in the final position of words.
What is responsible for intervention?
Audiologist: monitor hearing sensitivity, monitor amplification devices and communicate to tothers the effect of HL on speech acquisition.
SLP: stay current with language intervention techniques, establish family centere intervention.