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what are the four types of hearing loss: 1. conductive
2. sensori-neural
3. mixed
4. central auditory processing disorder
what are the test results of conductive loss: loss by air, normal by bone
what are the test results of sensori-neural loss: = amount of loss by air and bone (outer hair cells)
what are the test results of mixed loss: air bone gap.
can there ever be a greater loss by bone?: no
what is central auditory processing disorder? where is the problem found?: competing sounds difficult to separate. difficult to separate what they want to hear and what is in the background. problem found beyond the cochlea
what are four possible causes of sensorineural loss: 1. medication
2. noise
3. disease
4. skull fracture
degree of loss: 0-25dBHL: normal hearing
26-40: mild
41-55: moderate
56-70: moderately severe
71-90: severe
91-above: profound
in degree of loss, the range is defined by...and never by...: intensity level...never by percent
for children...what is normal and what is a slight loss: 0-15 normal
16-25 slight loss
why do children have different degrees of loss: an adult has had more noise exposure, a child should have better hearing, younger ears
what in the intensity of a conversation? vaccuum? kindergarten classroom? rustling leaves?: convo-55 dB hl
vaccuum- 85 dB hl
kindergarten class- 90 dB hl
rustling leaves- 15 dBhl
during a bone conduction test...what will always respond: the better cochlea, because the test vibrates the whole skull
what is habilitation: help aquire a skill that was never had
rehabilitation?: restore somethign they once had aquired
what is aural habilitation/rehabtilitation?: those efforts designed to help a deaf or hard-of-hearing person adjust tot he hearing loss, or to alleviate the effects of the hearing loss.
what are four types of activites are performed under the title aural rehab?: 1. hearing aids
2. cochlear implants
3. speech reading training
4. provide info to the persons with hl
what percent of ppl over 65 have a loss?: 50%
what percent of population has a loss: 10%
percent of ppl over 65 who have a loss and acknowledge it?: 41%
even though childhood incidence of HL had decreased...it is now increasing because...: medical technology is increasing..machines in hospitals. more people in population will have some degree of loss
the deaf or hard of hearing population in the US was estimated at approximately: 20 million/ 8.6% of population/- over 3yrs of age
are males or females more likely to be deaf or hard of hearing? why?: males- work, recreation, military
prevalence of HL at all ages decreases as family income...? why?: increases- healthcare, health issues, noise exposure
prevalence of HL is greater at all ages among people who live in...? why?: rural areas. one country doctor serves big area.
of the 20 million ppl in the US with HL, 3 out of 4 experienced onset of loss after age...: 18
of the 20 mill, what % had a prelingual loss?: 5
the average person think that a person should hear..how? with the hearing aid?: normally (which is not true)
how is HL defined? (2 models): A) degree, type, configuration= medical model
B) cultural communication factors= cultural model
what is hearing handicap: how a person's impairment effects their daily life.
what are 2 main effects of HL: 1. reduction in absolute sensitivity- audibility
2. reduction in differntial/ sensitivity. discriminating in frequency, temporal and intensity domains (distorted)
why can't you restore heraing to age 20: distortion
what are 4 secondary effects of HL: 1. emotional withdrawal/depression
2. transportaion/safety issues
3. education
4. independence
employment: what is the 4th reason not to hire a person: communication
a perceptual problem, a speech problem, communication problem, cognitive, social, emotional, education, intellectual, vocational, parental problem: all examples of what?: impact of HL on kids
age of onset of loss, progression of loss, degree, type, configuration of loss, symmetry of loss, other handicapping conditions, personality, support system, age of amplification : all examples of?: factors which influence the degree to which effects of HL are experienced
what is the most important info for speech? what range?: frequency found between 400-3000 Hz
what are the "speech frequencies (on audiogram): 500-2000 Hz
average dB of ordinary conversational speech sounds?: 30 dB
does reception ensure proper perception? 2 reasons why?: not necessarily
1. process of speech perception (is complex/ sophisticated)

2. recetpion of signal by auditory mechanism is only a beginning step in this process.
human ear has ability to detect what frequencies?: 20-20000 Hz
speech convo occurs between what frequencies: 400- 3000 Hz
human ear has ability to detect intensities from- to?: 1-130 dBSPL
human ear has ability to discriminate changes in? (3): 1. frequency
2. intensity
3. duration
human ear has ability to detect Hz changes of what %: 1%
human ear has ability to detect intensity changes of about what %: 10% or 1 dB
human ear has abilty to detect duration changes of?: 1/1000th of a second
detection of sound is? influenced by? (2): -awareness of sound
- influenced by hearing abilty (thresholds) and intensity of signal
discrimination: detect differences in sound stimulus pattern
identification: ability to indentify/label what was heard
recognition: correct identification of sensory data in terms of previous knowledge
what are some factors that interact withteh components listed above which affect speech perception? (3): 1. physcial properties of speech
2. redundancy
3. noise
slope of hearing loss: as steepness of slope increased listeners with high Hz HL had..: increasing difficulty perceving s, sh, th, t, ch
audibility above 2000Hz is crucial for perception of: s, sh, and voiceless sh
degree and slope is important when decideing on: aural rehab
acoustics of speech and audiogram of listener are not only factors influencing...: speech perception
redundance (within speaker, message communication environment, listener) of speech influences..: amount of infor in a message
redundancy is similar to: predictability
the more predictable a message is.. the greater...: the chance that the listener will perceive it correctly (even if he/she did not hear the entire signal)
what is a factor that prevents speech perception?: noise- factors that reduce the amount of info in a message available to the listenr.
noise is in direct conflict with?: redundancy- it reduces the redundancy in a signal, thus reducing the info available to the listener
role of vision in aural rehab (3 points): 1. communicaiton can take plance using vision modality
2. ppl with HL rely on vision to supplement imperfect or incomplete auditory info
3. visual info can be transmitted using oral or manual (gestures/ASL) communcation (lipreading)- speechreading, sign language
speechreading: process of using cues such as observign speaker's mouth, facial expression, and gestures to supplemetn audition and accurately perceive speakers' message
reliance on and amount of speechreading by a listener is usually directly proportional to: degree of hearing loss
several factors that affect speechreading (4): 1. speaker
2. signal/ code/ what is being said
3. environment
4. speechreader (experience)
speaker-effects (5): 1. familiarity
2. use of appropriate facial exp./gestures
3. rate
4. competing factors reduced when familiar
5. gender- women easier-more animated
visual/auditory contribute to understandign: need to know speech features that contribute to both audtory/visual speech perception in order to (3): 1. predict consonatn confusions
2. describe erros
3. order errors hierarchically
viual phonemes (visemes): any visual individual and constrative visually perceived unit
3 characteristics of visemes: 1. contains more than 1 speech sound ( but can contain only 1 independent viseme
2. sounds within visemes are all produced with similar patterns and listener perceives overal pattern
3. vismes exist for vowels/ consonants
speechreading movement: any easily seen motion
pattern common to 2 or more speech sounds (2): 1.sounds in a speechreading movement are very similar yet not identical
2. can describe vowels and consonants
visemes: what is the strongest feature for consonants? (voicing not audible): place of articulation
diphthongs are easier or harder to correctly identify than vowels: easier
t/f all talker produce the same number of vismes: false
what has the ability to cloud the visibility of speech soudns: coarticulation
what is the % of words produced in convo speech that are visibly indistiguishable?: 50%
factors affecting speechreading: (1): environment
4 factors of environment: 1. distance
2. visibility
3. angle
4. cues
what is the optimal distance from the speaker?: 5 ft
speechreading ability drops off significantly at what distance: 20 ft
visibility has to do with: illumination contrast between speakers face and background (lighter)
what is the ideal angle? what is acceptable?: 0 degrees. 45 is acceptable
what does cues have to do with: use of appropriate environmental cues
what are 3 factors affecting the speechreadER: 1. age
2. gender
3. visual skills
the ability to speeechread is linked with: emergence of language skills.
older individuals tend to be more or less proficient than younger? why? (2): less. visual acuity reduced. elderly more difficult processing temporally changing visual info
adult females are better or worse than males?: adult females are better at speechreading than males.
visual skills-what greatly affects acuity. what do you need?: slightly reduced acuity negatively affects speechreading. need atleast 20/80
visual skills- perception..whats the link?: perception- intuition; ability to synthesize limited input (visual closure)
what is the primary way to take in information: hearing
what type of hearing is used with speech reading: residual hearing
what are the 2 approaches to speechreading: 1. synthetic approach
2. Analytic approach
what is synthetic approach to sr: emphasizes? comprehension of? recognition of? examples?: emaphasizes reception of the whole

comprehension of hte genreal meaning of hte message, rather than identifying each component.

reconition of key words, sentences and phrases crucial to visual perception.

some examples: provide an approprate verbal description of a picture.....identify content of a paragraph
analytic approach to SR- must first perceive? recognition of? examples?: must first perceive phonemes in a word before a word can be perceived, and so on

reconittion of phonemes and syllables in isolation are key to visual perception.

some exampes of analytic activities: initial consonant description (pal vs nal)

identify a single words spoken from closed set (give three choices)
children and SR- what type of approach? therapy based on?: - highly individualized approach with children\
- based on children's abilities and real life needs
with children what is the plan of action/: - give the child sound (hearing aid, cochlear implant) and consider communication approach chosen by the family. will always use audition and visual (make use of all opportunites)
childrens brains are more...they...speechreading: flexible....they catch onto SR quicker
Adults and SR- longterm therapy? what type of setting?: long term therapy programs can incorporate both analytic and synthetic aspects

therapy can occur either in an individual or a group setting, or a combination of the two
what are the two advantages to group therapy: 1. moral support
2. practice with different individuals
components of SR therapy can also inculude topics like (3): understanding hearing loss, use of amplification, communication strategies
what is another option other than SR: self instruction videos, computer programs
Speechreading assessment: what is the universal battery? how is the decision made? what type of measure? tapes or live presentation?: no univeral test battery
decisions made individually
both informal and formal meausures used
present tapes (more standardized) or live presentation (more engaged, lose objectivity)
what are the two diff ways materials can be presented?: by vision alone or with audition and vision (know how much will change when add sound)
what are the five types of manual communication: 1. american sign language
2. signed english
3. pidgin sign
4. finger spelling
5. cued speech
Signed English (Bornstein) -follows what syntax? uses markers(like what) to denote what? widely used in?: - follows eng syntax and grammar
- uses markers to denote word affixes and suffixes, such as -ing, -ed, -s
- widely used in education (deaf child in regualr classroom)
Signing exact english (SEE 2)- signs are based on? all affixes are signed or not? follows which word order? widely used in?: - signs are word based
- all affixees are signed
- signed is strict accordance wtih english word order
- widely used in education
signing essential english (SEE1)- signs are based on? more or less labor intensive than SEE 2? extreme form of? popular?: - signs are based on morphemes
- more labor intensive than SEE 2
- extreme form of word-based signs
- never gained wide spread popularity
linguistics of visual english (LOVE)- similar to? used in?: - similar to SEE 2, each sign can be written
- used in education, although useage is dwindling
ASL- what kinda of language? uses what mode? follws what grammar? signs based on? official lang of?: - independent language
- uses visual-manual mode
- has its own grammar, syntax, dialects, vocabulary, slang, puns
- signs are meaning based
- official lang of deaf community
pidgin sign language- combines elements of? used in conjunction with? contains many or few sign markers? frequently uses? signs based oN/: - combines elements of ASL and other sign systems
- used in conjunction with speech in interpreting
- contains few sign markers
- frequently uses English finger-spelled words
-signs are meaning based
cued speech- aid to? helps clear?: - aid to oral communication (lip/SR), used in conjunction with lip movements
- helps clera up ambiguities in lip reading
viseme: phonemes that look exactly the same
with cued speech: how many hand shapes and how many positions: - 8 hand shapes in 4 positions on the face
what is auditory training?: -teaching a child or adult with hearing loss to maximize auditory information (residual hearing)
child/ auditory training: acquisition/ developemnt of auditory perception abilities
what is a must wtih AT: proper ampllification
often the mouth is?: obscured during AT so input to hte listener is purley auditory
goals of AT: develoopment of the ability to recognize speech using audition and interpret auditory experiences. the listener maximizes residual hearing and the auditoyr signal
objective for child/ at: reation of communication environemtns where children with HL apply auditory sense to fullest capacity in language communication
objectives for adults/ at: maximize use of auditory/ other info related to speech perception

adjustment and orientaion to amplification, to optimize use of assistive devices
Historical perspectives: AT was originally calle? Broght to US in? by?: -origninally called acoustic method. broguht to US in 1939 by Max Goldstein- founder of CID (Central institue for Deaf)
AT emphasis on?: systematic stimulation with phonemes, syllables, words, etc
at originally used for: speech perception and production training for deaf children
after WWII, auditory trainign used for: adults wtih mild to sever HL
what are the four groups of people who are candidates for AT?: 1. children with prelingual SNHL usually moderate-profound range with congenital onsent (present at birth)
2. children with postlingual SNHL
3. Select groups of hard of hearing adults
4. New cochlear implant users, both adults and children
What are the 4 major objectives of AT for children: 1. development of sound awareness
2. development of gross discrimination (this or that sound) cow vs. duck sound
3. development of broad discriminations. simple speech patterns- moo v. baa
4. development of finer discriminations for speech- pat vs pot
what are the four levels of auditory skill development: awareness- discrimination- identification- comprehension

awareness- easy
comprehension- difficult
AT for Children: assessment of Auditory Skills: - what are the limitations of the children? - therefore...informal assessments... - for infants, determine... - for older children, determine...: - limitations= cognitive and linguistic skill levels
- therefore, informal assessments and observations are frequently used
- for infants, determine extent to which audiotry skills have emerged
- for older children, determine speech perception skills
Tests for AT for children: - WIPI (Word Intelligibility by Picture ID)
- NU-Chips (Northwest University Children's perception of Speech)
- Ling Six Sound Test (a,u,i,s,sh,m)
- Tac( Test of Auditory Comprehension)
- Gasp (Glendonald Aud. Screening Procedure)
- DASL (Developmental Approach to Successful Listening)
- IT-MAIS (Infant- TOddler Meaningful Auditory Integration Scale)
Tests for AT for Adults: - traditional monosyllabic word list (NU-6, CID W-22)
- CCT (California Consonant Test)
- SPIN (Speech Perception in Noise)
- CID EVERYDAY SENTENCES
- MAC (Minimum Auditory Capabilities)
- Iowa Cochlear Implant Battery
Primary consequence of HL: speech delay
lang delay can effect (4): - self concept
- emo dev
- fam relationship
- social skills
self concept: how one sees oneself. concept is leanred by interactions with the environment around us
children with HL at risk for dev of: poor self concept
why does HL cause poor self concept?: neg. feedback/ reactions due to communication difficulties

cosmetic concerns "hearing and effect"
preschoolers are shown to have fewer negative images
emotional development: (3) points: 1. difficulties with lang. sometimes = difficulty with self- expression, understanding of emotions
2. miss opportunities to overhear and learna bout strategies to deal with emotions
3. importance of understanding emotion vocabulary
Family concerns: range of emotions that family experiences with first learning aobut hl: - grief, inadequacy, anger, guilt, confusion, vulnerability (what's next)

- effects on other family members
Social Competence (3 POints: 1. language difficulties- difficulties with peer- interactions, relationships
2. pre adolescent children with HL are more fearful of being teased and spend more time alone than age matched peers
3. problems become more intense in adolescence as social pressures increase
the current move in thearpy is towards which approach? explain.: family- centered approach
- family is viewed as clinet- not just the patient. parent is partner. clinician presents all info- parents make own decision. equal in assessment, intervention and decision-making)
define language: a set of symbols and rules established by a community to express meaning and facilitate communication
the deteriorated speech signal resulting from heraing loss robs the child of information regarding:: form (phonolgy, syntax, morphology)

content (semantics)

use (pragmatics)
primary comsequence of childhood HL: language delay
Factors affecting Language acquisition (6): - degree of loss
- age of onset
- other disabling conditions (vision)
- non-verbal intelligence
- family communication
- intervention programs (access to services)
significance of early intervention:: a greater number of children are being identified with HL before age of six months due in large part to newborn hearing screening.

- receptive and expressive language skills
- pragmatics
- syntax and morphology
- phonology
three to four months: use non-verbal communication behaviors- gestures, move, cry, vocalize
6-12 months: evidence of intentional ocmmunication- gesture/vocalize repeatedly until goal is reached
prelinguistic/ 1 word stage:: hearing child will gradually reduce use of gestures

hard of hearing/ deaf child may increase non-verbal behaviors between 6-36 months
language interactions with the deaf/ hard of hearing child: (3): 1. caregivers modify communication style when caring for young children (motherese)
2. similar communication interactions are seen with deaf parents/ deaf children and hearing parents/ hearing child
3. hearing parents/ deaf child paradigm: shorter, less complex communication interactions, than either of the other groups (regardless of communication mode (uncertantly, less feedback)
degre of participation of mothers/ fathers: which more?: - mothers talk more
vocabulary skills of deaf/ hard of hearing preschool children: 4 yr old children with normal hearing had an approx how many words? - 4 yr old children who are deaf had how many words?: normal: 2000
deaf: 158
what are the four things that were different when those numbers were takeN/: 1. early intervention wasn't madated
2. hearing aids weren't good
3. technology unsophisticated
4. way before cochlear implants
early exposure to sign language creats?: a large spoken vocal than exposed to oral lang only. because child already has idea about what language is
they found that children in total communication programs had: lqarger vocabularies than age-matched peers in oral programs
language characteristics of Preschoolers with HL: knowledge of Schema: children with HL have limited knowledge about the world (3) points:: 1. limited access to lang.
2. miss incidential learning opportunities
3. limited practice using lang.
lemantics and Pragmatics: children with HL (2-4 yrs old) have same semantic and pragmatic functions as children with: normal hearing in the one-word stage (2 yrs)

-> lang delay
syntax/morphological skills (4) points: 1. restricted knowledge of word classes (noun verbs)- over use of nouns and verbs- omission of function words
2. restriced knowledge of syntax- overuse of SVO structure
3.overall syntactice delay with plateau
4. deviant syntax seen in child with profound loss (missuse of morphological markers: frequently for past tense or plurality

asequential word order: saw dog brown (ASL
pragmatic skills:: older children with HL can have difficulties iwth conversational turn-taking, topic initiation and maintenance, repair strategies

why? relies on receiving auditory cue- won't hear cue
langage acquisition plateau: (2 points: 1. some studies suggest that lang skills plateau around age 11-13 in children with severe loss
2. other studies have shown that lang skills can still imporve beyond school age

- they don't know
speech characteristics: mild moderate severe loss (<70) (4 ) points: 1. relatively intelligible talkers as a group
2. primary speech errors:art, of single consonatns/ consonant blends
- omission of final consonnats. omission or distortion of blends/affricates. ommissioin of voiced consonants particularly frcatives
3. vowel/suprasegmental errors rarely seen. least common errors: stop, plosives, nasal glide
4. speech errors resemble those of younger children wtih normal hearing
speech management: children with mild to moderate HL: 4 points: 1. appropriate amplification
2. art and pohonolgical therapy
3. aided thresholds and everyday sounds audiogram: thershold with hearing aids on plots person's threshold on everyday sound audiogram to illustrate what the person can't hear
4. coarticulation effects- can effect speech intelligibility
speech characteristics: sever to profound (> 70)(3): 1. average speech intelligibility score is 20%- the amount is understood by the listener
2. "stacks of erros which are complex and interrelated
3. talk about speech in terms of respiration, resonance, pohnation and articulation
respiration (4 points): 1. difficulties in speech breathing
2. only a few syllables were spoken per exhalation
3. low lung volume at initiation of and during speech
4. air is lost during short adjustment period immediately prior to phonation
resonance (2): 1. hyponasality and hypernasality seen
2. improvemtn in resonance (nasality) might require the talker to make use of auditory nasality cues
phonation 3: inadequate vocal fold adduction

overal perception of breathy voice quality

voiceless consonants substituted for voiced consonants
suprasegmental/ prosodic features: aspects of an utterance that span linguist units longer than phonetic segment

reveal attitueds and emotions

contour of Fo vs time (intonation)

interrogative vs. declarative

duration
pauses
assignment of relative stress

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