SHS 451 – Aural Habilitation and Rehabilitation for Children and Adults

Guided Worksheet 1: Chapters 1 and 2

Week 1
Our main topics for Chapter 1 will be

1. Definition of aural rehabilitation

2. Components of a typical aural rehabilitation
3. Degree and type of hearing loss
4. Auditory system
5. Evidence-based practice

Our main topics for Chapter 2 will be

1. Pure-tone audiometry
2. Speech audiometry
3. Test procedures
4. Importance of multicultural testing

Chapter 1

Define aural rehabilitation: Aural Rehabilitation is used in adults who developed speech, language and
auditory skills but need rehabilitation in order to refine or establish skills that have become impaired due
to hearing loss.

Give a brief explanation of the International Classification of Functioning, Disability, and Health
(ICF): A classification system that provides a biopsychosocial framework for describing a health
condition. Describes consequences of a health related condition within the context of the patient's
environment and circumstances and takes into account the nature and extent of a patient's functioning.

Give a brief description of the components of aural rehabilitation:

● Perceived quality of life: “Self-assessment of the current life experiences and includes such
things as enjoyment, meaning, purpose, usefulness, value, freedom of choice, and independence.
It is influenced by function, activity, and participation, but is by no means completely determined
by them”
● Tinnitus management: Assessment of tinnitus disability and provision of means to gain relief or
control over the sensation of tinnitus
● Hearing protection: Assessment of sound levels and provision of hearing protection materials
● Auditory training
● Communication strategies: Teaching of strategies that enhance communication and minimize
communication difficulties (facilitative strategies, repair strategies, environmental management)
● Others? Counseling, Sensory Management...

Give some examples of who performs aural rehabilitation and where it occurs:
 - Audiologists take the lead role in providing treatment for adults. SLPs provide direct treatment
for children, especially in school environments. Aural Rehabilitation is provided for patients
through a network of collaborating professionals in a variety of settings
- Aural Rehabilitation occurs at:
- Audiologist office
- An SLP’s or otolaryngologists office
- Consumer organization meetings
- The home, sometimes web-based
- Community center or nursing home
- VA hospital, or military or veteran center
- Virtually

List the different degrees of hearing loss: Normal, Mild, Moderate, Moderately-Severe, Severe,
Profound

Unilateral vs bilateral:
- Unilateral: One ear is affected
- Bilateral: Both ears have reduced sensitivity
Prelingual vs perilingual vs post lingual:
- Prelingual: A hearing loss acquired before the acquisition of spoken language. (typically before
the age of 2)
- Perillingual: While a person is acquiring language
- Postlingual: After a person has acquired language (typically after 5 years)
Congenital vs acquired:
- Congenital: Present at birth
- Acquired: After birth
Progressive vs sudden
- Progressive: is a hearing loss that increases over time.
- Sudden: s a hearing loss that has an acute and rapid onset.

Define three types of hearing loss:

Conductive Hearing Loss: “Stems from an obstruction in either the outer or middle ear that prevents
sound from reaching the sensorineural structures in the inner ear. An obstruc- tion might be congenital,
such as microtia or atresia, or it might be acquired, such as cerumen accumulation in the ear canal or
otitis media in the middle ear. “
Define:
- Otitis media: Inflammation of the middle ear, often accompanied by the accumulation of fluid in
the middle ear cavity.
- Microtia/atresia: Microtia is a congenitally small external ear. A congenital closure of the
external auditory canal is called atresia.
- Cerumen: Earwax
Mixed: Both a conductive and a sensorineural hearing loss. For example, a child who has congenital
sensorineural hearing loss may have mixed hearing loss if he or she suffers a bout of otitis media.

Sensorineural: A disturbance in the inner ear, eighth nerve, brainstem, midbrain, or auditory cortex.
Sensorineural losses are typically permanent.
Define:
- Meningitis: Postnatal infection, common cause of childhood sensorineural hearing loss caused
by bacterial or viral inflammation of the meninges. The meninges are the membranous linings of
the brain and spinal cord.
- Ototoxic drugs: Harmful to the structures of the inner ear and the auditory nerve.

Auditory system
- Outer ear: includes the outside of the ear and the ear canal up to the level of the tympanic
membrane (eardrum).
- Middle ear: includes the cavity behind the tympanic membrane that houses the three tiny bones
or ossicles (malleus, incus, stapes) responsible for mechanically conducting sound waves to the
inner ear.
- Inner ear: Contains the cochlea and semicircular canal. The Cochlea is a fluid filled and contains
sensory cell and the Semicircular canal is responsible for balance
- Define:
- Cochlea: the snail-like structure that houses the cells responsible for responding
to sound and transmitting it to the auditory nerve
- Semicircular canals: Integral for sense of balance.

Evidence-based practice:
- Why are outcome measures important? An outcome measure indicates the amount or type of
benefit experienced by either an individual or a group of individuals to a treatment or series of
treatments, and/or indicates a response.

- What 3 components make up evidence-based practice? Current best evidence, Patient values,
and Clinical expertise

Describe the following components of an experimental design:

- Randomized controlled trial: Entails comparing participants who have been randomly assigned
to receive a test treatment to participants who receive no such treatment or a different test
treatment.
- Meta-analysis: A study of studies that combines the results of a set of studies on the same topic
to reach a general conclusion.
- Control group: Composed of research participants who closely resemble members of the
experimental group but who do not receive the experimental treatment and thereby serve as a
standard against which to detect and measure changes in the experimental group due to the
treatment.
 - Independent variable: The variable that is manipulated by the experimenter in order to assess its
consequences or impact on the dependent variable.
- Dependent variable: The variable that is affected by the treatment or manipulation of the
independent variable and can be measured.

Give a brief description of the 5-step approach to evidence-based practice:

1. Select an auditory training program
2. Make a random assignment
3. Measure speech recognition
4. Assess and compare
5. Make conclusions
Chapter 2
Pure-tone audiometry
Define:
- Air conduction: When sound travels through the air into the external auditory canal and
stimulation progresses through the middle ear, inner ear, and to the brain.
- Bone conduction: Transmission of sound through the bones in the body, particularly the skull.
- Air-bone gap: The difference between air and bone conduction thresholds; a difference may
indicate a conductive component in the hearing loss.
- Sound level and frequency: Sound level is the intensity of sound expressed in decibels.
Frequency is the number of regularly repeated events in a given unit of time; usually measured in
cycles per second and expressed in Hertz (Hz).

Speech Audiometry
- Why is speech testing important?
- Speech testing can illustrate how speech understanding is impared relative to persons
who have normal hearing. An audiologist can gain information that can be used to
counsel patients about their particular listening difficulties.
- Difference between speech reception threshold and speech recognition score?
- Speech reception threshold (SRT) is the lowest presentation level for spondee words at
which 50% can be identified correctly. A word recognition score (WRS) refers to the
percentage of monosyllabic words presented at a comfortable listening level that can be
correctly repeated.
- Example of spondees: Two-syllable words spoken with equal stress on each
syllable. “Baseball, ice cream, hotdog, sidewalk…”

- List some purposes for speech recognition testing: Performed to determine how well an
individual can recognize speech units
- To determine need for amplification
- To compare different listening devices
- To compare performance with a listening aid to performance without a listening aid to
build patient confidence
- To demonstrate to patients that their ability to recognize speech is diminished.
- To access performance longitudinally
 - To obtain information that might elucidate environmental listening issues.

- UCL and MCL:

- UCL: Uncomfortable Loudness Level:
- The threshold level at which the speech changes from being comfortably loud to
being uncomfortably loud.
- MCL: Most Comfortable Loudness Level:
- The level at which speech is most comfortable to listen to.
- Dynamic range: The difference in decibels between a person’s threshold for just being able to
detect speech and the person’s threshold for uncomfortable listening.
- Sound field testing: Determines hearing sensitivity or speech recognition ability by presenting
signals in a sound field through a loudspeaker.

- Why is consideration of communication mode important?

- Communication mode is the means used by a sender to share information with a
receiver and may include speech, sign writing, hand gestures, or any other system of
shared symbols.
- This is important because if, for example, “a patient uses sign language, the test
instructions should be presented with a sign, and provisions for recording the
patient’s responses must be made (i.e., if the patient signs responses, then
someone must interpret them). If a patient has decreased speech intelligibility as
well as a hearing loss, and is not a young child, you might ask the patient to write
down what he or she hears.”

Give an advantage of using each of the following stimuli during speech testing:

- Nonsense syllables:
- Performance unaffected by a patient’s vocabulary level
- A feature analysis can often be performed
- Disadvantages of nonsense syllables:
- Poor face validity
- Words
- Have a somewhat higher face validity than nonsense syllables
- Easy to score
- Permit fine-grained scoring
- Performance is not affected by patients ability to use context or knowledge of linguistic
structure.
- Sentences/ Phrases
- High face validity
- Likely to reflect real word performance
- Features of sentences:
- Prosodic cues: Cues provided by intonation, rate, and duration of speech sounds.
- Contextual information: Linguistic support available for identifying a target
word, phrase, or sentence.
 - Coarticulation: The influence of one phoneme on either a preceding or
succeeding phoneme.

Test Procedures
- White noise vs speech noise:
- White noise: A broadband noise that has equal energy at all frequencies.
- Speech noise: A broadband noise that has been filtered so that it resembles the speech
spectrum.
- Closed set vs. Open set:
- Closed Set: A stimulus or response set that contains a fixed number of items known to
the patient.
- Open Set: Task or test does not provide choices.

- What is signal-to-noise ratio and why is it important?

- The level of a signal relative to a background of noise. It is important because it indicates
the difference between the sound level of the signal and the sound level of the noise.
- What are some possible disadvantages to using live voice? Why use recorded stimuli?
- Live talkers can introduce variability from one test session to the next and from one test
site to another. Talkers have different speaking styles and they may vary in their style
from one day to another.
- Recorded stimuli are presented via a computer, tape recorder, compact disk (Cd) player,
MP3 player, or a digital video disk (dVd) player.

Define:
- Synthesized speech: Created with a computer, not the human vocal tract.
- Altered speech: Human speech that is recorded and then altered in some way.
- Filtered speech (low-pass filter and high-pass filter): Passed through filter banks for the
purpose of removing or amplifying frequency bands in the signal.
- Low-Pass: has been passed through filter banks that removed the higher, but not the
lower, frequencies.
- High-Pass: has been passed through filter banks that removed the lower, but not the
higher, frequencies

- Describe learning effects and how they can be alleviated: Learning effects occur when
performance on a test improves as a function of familiarity with the test procedures or items, not
as a result of a change in ability. One way in which the learning problem has been addressed is
with the use of equivalent lists, that is, sets of sentences that are presumed to be equally difficult
to recognize. Equivalency is usually established by playing the separate tests to a large group of
participants.

- Test-retest variability: A measure of the consistency of performance on a test from one

presentation to the next.
- What can shift test scores?
- Mode of presentation
 - Location
- Talker
- Number of times an item is repeated
- Test-retest reliability: The degree to which a group of test takers will achieve the same scores
with repeated administrations of a test.
- Why is it important to consider multicultural issues?
- Perform differently on speech recognition tests. “Spanish tests of speech recognition
yield better performance than English tests for native Spanish bilingual individuals. Some
evidence suggests that Spanish-English bilingual listeners are more adversely affected by
background noise than are monolingual English listeners.”
- Monolingual: Person who speaks one language
- Bilingual: Person who speaks two languages