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COSD Final Exam Study Guide

by: Maycie Tidwell

COSD Final Exam Study Guide COSD 10303

Maycie Tidwell
GPA 3.8

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This is a study guide for the final exam!
Survey of Communication Disorders
Study Guide
COSD, communication, disorders
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This 26 page Study Guide was uploaded by Maycie Tidwell on Thursday April 28, 2016. The Study Guide belongs to COSD 10303 at Texas Christian University taught by Watson in Spring 2016. Since its upload, it has received 19 views. For similar materials see Survey of Communication Disorders in Nursing and Health Sciences at Texas Christian University.

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Date Created: 04/28/16
COSD 10303 Review for Final Exam Chapter 6: Adult Language Impairments Aphasia (left hemisphere) Right Hemisphere brain damage TBI Dementia 1. Describe the form, content and use of language in adults  Use o Adults are skilled conversationalists o Narratives improve until the seventies  Content o Some words fade and others are added o Deficits in accuracy and speed of word retrieval/naming  Form o Continue to acquire some aspects of syntax o Complex sentence construction declines with advanced age 2. Describe the nervous system a) Neuron: a specialized cell transmitting nerve impulses; a nerve cell. Cranial Nerves: Nerves specifically important for motor speech and hearing a. Central nervous system  Brain o Cerebrum o Cerebellum o Brainstem  Spinal Cord b. Language processing  Brocas’ Area  Frontal lobe  Production of language  Wernicke’s Area  Left temporal lobe  Comprehension of language 3. Describe aphasia in terms of the following: Incidence: Affects over 1 million people in the U.S. Causes – types of CVA: Stroke is the primary cause  Stroke or cerebrovascular accident (CVA) o Effect ½ million annually in U.S. of whom approx 100,000 become aphasic o Ischemic—Complete or partial occlusion of arteries  Cerebral arteriosclerosis (thickening and build up), embolism (traveling aka en route), and thrombosis (does not travel)  Transient ischemic attack (mini strokes)  Loss of consciousness, headache, weak or immobile limbs, slurred speech o Hemorrhagic—Burst blood vessel  Aneurysm and arteriovenous malformation (tangle of arteries and veins (malformed))  Head injury, infections, disease, and tumors  Risk factors for stroke: Smoking, alcohol use, poor diet, lack of exercise, high blood pressure, high cholesterol, diabetes, obesity and history of strokes Language deficits (expression and comprehension)  Expressive deficits: o Reduced vocabulary o Omission/addition/substitution of words o Stereotypic speech (Repeating words) o Delayed or reduced output of speech o Hyperfluent speech (say a lot with no meaning)  Language comprehension deficits  Range of severity based on o Cause o Location and extent of injury o Age of injury (young people recover better) o Age and general health of client  Disorder can be categorized into syndromes based on similarity in patterns of behavior  Often accompanied by apraxia and/or dysarthria (motor speech problems)  Seizures in about 20% of aphasic adults  Depression may be present Concomitant accompanying deficits (e.g., hemiparesis, agnosia, neologisms, paraphasias)  Hemiparesis: hemi means half, paresis means Weakness  Hemiplegia: Paralysis  Hemisensory impairment: Loss of the ability to perceive sensory information (can’t feel pain)  Hemianopsia: visual processing difficulties affecting ability to read (blindness in R visual field)  Dysphagia: when paresis, paralysis and/or sensory impairment affects chewing or swallowing  Agnosia: Deficit in understanding sensory information (e.g., visual agnosia in the Man who Mistook his Wife for a Hat)  Agrammatism: Omission of grammatical elements  Agraphia: Writing difficulties  Alexia: Reading problems  Anomia: Naming problems  Jargon: Meaningless speech with typical intonation. Aka Fluent aphasia   Neologism: A novel word (e.g., pen>”badle;” chair> “ponty”)  Paraphasia: Word and phoneme substitutions o Phonemic (sounds): hiss for kiss, Loose for juice o Verbal: husband for wife, walkside for sidewalk  Verbal stereotype: Expression repeated over and over (e.g., naked lady; obscenties) Types of aphasia and associated communication difficulties: Fluent Aphasia (not good)  o Word substitutions, neologisms, and often verbose verbal output o Lesion in posterior part of L hemisphere Wernicke’s Aphasia (Maisy has this) o Rapid speech, jumbled content o Poor auditory and visual comprehension o Verbal paraphasia or unintended words and neologisms o Jargon o Mild to severe impairment in naming and imitative speech o Maisy’s speech ▯ Anomic Aphasia o Word retrieval difficulties o Fluent spontaneous speech with word retrieval difficulties o Mild to moderate auditory comprehension problems ▯ Conduction Aphasia o Paraphasia (can be to the point of incomprehensible) o Anomia o Only mild auditory comprehension problems o Poor repetitive or imitative speech ▯ Subcortical Aphasia o Fluent expressive speech o Paraphasias and neologisms o Repetition, listening, and reading unaffected o Cognitive deficits and reduced vigilance Nonfluent Aphasia:  Slow, labored speech  Word retrieval and syntactic problems  Site of lesion in or near the frontal lobe in L  Broca’s Aphasia (most common non fluent) (Carl has this)  Broca’s area: Motor planning and working memory  Short sentences with agrammatism  Anomia  Slow labored speech and writing  Problems with imitation  Articulation and phonological errors  Transcortical Motor Aphasia  **Difficulty initiating speech  Mild comprehension deficit  Good verbal imitative abilities  Global or Mixed Aphasia  **Profound impairment in all modalities  Most severely debilitating aphasia  Limited spontaneous expressive ability or stereotypes  Naming and imitation affected  Auditory and visual comprehension deficits ***TEST Q: know the difference between fluent and nonfluent and focus on Wernicke’s and Broca’s Aphasia. Patterns of recovery for strokes:  Ischemic o Improvement within the first weeks after injury o Recovery slows down after 3 months  Hemorrhagic o More severe after injury o Most rapid recovery at the end of the first month and into second month Lifespan issues:  Mostly middle-aged and beyond  Risk increased with history of o Smoking o Alcohol use o Poor diet o Lack of exercise o High blood pressure o High cholesterol o Diabetes o Obesity o TIAs / previous strokes  First indications o Loss of consciousness o Headache o Weak or immobile limbs o Slurred speech  Can be temporary or permanent  Hospitalization o One third die from the stroke o Long, deep coma is indicator of possible poor recovery o Acute care followed by rehabilitation services when client’s condition permits  Aphasia may be accompanied by neuromuscular deficits, seizures, & dementia o They do not cause aphasia  Behavior, emotional, & social changes and possible personality changes  Spontaneous recovery o Fastest recovery during the first few weeks and months after incident o Recovery slows, usually ceasing after 6 months o Recovery better and faster in  Younger  Less severely affected  Good health  Left-handed o Usually the earlier treatment the better Assessment for aphasia:  Medical history—Previous health and current neurological reports  Interview with client and family—SLP receives and gives information  Oral peripheral exam  Hearing testing  Speech and language observation and testing o Initially informal at bedside  Counseling is ongoing  Formal testing postponed until patient is stable  Address  Overall communication skills  Expressive language  Receptive language  All modalities across all aspects of language  Listening, expressive output, reading, writing, gestures  Standardized tests are available  Observation/interpretation of client behavior Treatment, including goals:  Goal: Aid recovery and provide compensatory strategies (TEST Q)  Determined by assessment and client/family needs  Cross-modality generalization (e.g., comprehension and production)  Conversational techniques  “Bridging” between cerebral hemispheres (e.g., using R brain with gesture)  Multimodality stimulation  AAC  Neural plasticity  Involve family members 4. Describe right hemisphere brain damage in terms of the following:  Group of deficits resulting from right cerebral hemisphere injury  Characteristics o Neglect information from left side (ex: only shave the right side) o Unrealistic denial o Impaired judgment and self-monitoring o Lack of motivation o Inattention  Can have a strong impact on communication (about half of RHBD indvidualshave trouble communicating) Language Characteristics of RHBD:  Both receptive and expressive  Pragmatics most impacted—Topic maintenance, use of contextual cues  Poor auditory and visual comprehension o May be very concrete (e.g., problems with humor) o Poor judgment in identifying and using important information (e.g., includes irrelevant information) o Paralinguistic deficits with problems in comprehending and producing emotional language o Aprosodia: reduced ability to produce or comprehend affective aspects of language- they sound “flat,” monotone. 2 main areas of Additional Deficits:  Attentional deficits o Left visual neglect  Visuospatial deficits (trouble with visual memory) o Poor visual discrimination o Poor scanning and tracking o Difficulty recognizing faces (including family members), remembering routes, reading maps Assessment for RHBD:  Visual scanning and tracking  Auditory and visual comprehension  Direction following  Response to emotion  Naming and describing  Writing  Observation is essential for pragmatics  Portions of aphasia batteries, standardized measures for RHD, and nonstandardized measures can be used  Your focus is to find out their strengths and their weaknesses Intervention for RHBD:  Begins with visual and auditory recognition (needed for more complex tasks)  Respond appropriately in conversation  Track more complex information  Use time restraints in conversational turn  Sequencing and explaining actions (organize linguistic information)  Synthesize skills within conversation  Target nonlinguistic markers (e.g., eye contact, body language, gestures) 5. Describe traumatic brain injury in terms of the following:  Disruption in normal functioning caused by a blow or jolt to the head or penetrating injury  Leading causes o Falls o Motor vehicle accidents o Blows to the head o Assaults  Caused by blow or jolt to head or a penetrating head injury (e.g., falls, motor crashes, sports, assaults)  Highest risk for TBI: 0-4 years and 15-19 years  1.4 million people sustain TBI annually  5.3 million Americans require long-term help post-TBI (2% of US pop)  Twice as many males  Diffuse injury to the entire brain o Infection o Bruising and laceration of brain o Edema o Hypoxia (lack of oxygen) o Intracranial pressure (drill in brain and blood comes out) o Infarction (death of tissue deprived of blood) o Hematoma (focal bleeding)  May have sensory, motor, behavioral, and affective disabilities  Epilepsy, hemisensory impairment, and hemiparesis/hemiplegia (weakness) may occur Characteristics of People with TBI:  Inability to resume daily living tasks and interests  Affects Cognitive areas: orientation, memory, attention, reasoning/problem solving, executive function-> (i.e., planning, executing and monitoring goal-directed behavior. Ex: figuring out your class schedule)  Language impacted in 3 of 4 TBIs – anomia (word retrieval) & comprehension  Most disturbed language area is pragmatics (e.g., errors in judgment and inability to inhibit behavior)  Deficits may also include: o Speech (1/3 have dysarthria) o Voice o Swallowing o Psychosocial/personality changes  Severity related to initial levels of consciousness and post- traumatic amnesia Life Span Issues with TBI:  Most are young, result of vehicular accident  Several stages of recovery: (don’t have to memorize each stage, just generally know them)  Initially, nonresponsive and require full assistance  Gradually respond to stimuli and recognize some individuals  Confusion and agitation  Inappropriate, incoherent, emotional language  Later, can remain alert and hold short conversations  Oriented to person and place, not time  Inappropriate, unaware, unrealistic, and uncooperative  In later stages of recovery, can initiate and carry out tasks  May consistently behave in a socially inappropriate manner  Periodic depression and irritability  Most will have lingering deficits, especially in pragmatics Assessment for TBI:  Interdisciplinary o Neurological, psychiatric, and psychological reports are very important for SLP  Ongoing and varies with stage of recovery o Observation o Few specifically designed tests o Sampling of pragmatic behaviors Intervention for TBI:  Cognitive rehabilitation—designed to increase functioning abilities in everyday life o Restorative o Compensatory approaches  Varies with stage of recovery o Initially orientation, stimulation, & recognition o Next memory, executive function, vocabulary, and language form o Then higher language functions, pragmatics, and independence  GOAL: To restore everyday functioning/activities 6. Describe dementia in terms of the following:  Impairment of intellect and cognition due to neurogenic causes o 15% of elderly with 20% of those responding to treatment, increasing incidence with more elderly o After age 65, many more cases (e.g., nearly half of those admitted into long-term care facilities)  Includes several conditions and syndromes  Memory deficits, poor reasoning, impaired abstract thinking, inability to attend to relevant information, impaired communication, and personality changes 2 Types of Dementias:  Cortical—Visuospatial deficits, memory problems, judgment and abstract thinking disturbances, and language deficits in naming, reading and writing, and auditory comprehension o Alzheimer’s (60 -80% of all dementias) & Pick’s  Subcortical—Deficits in memory, problem solving, and language; related motor problems o Multiple sclerosis o AIDS-related encephalopathy o Parkinson’s o Huntington’s Alzheimer’s:  Affects 13% of those over 65 o 50% of those over 85 th  5.5 million people in US; 6 leading cause of death (CDC, 2013)  More common in women by 2-3:1  Cause may be genetic and environmental  Twisted neuro-filaments in neurons especially in temporal lobe and associational pathways o Resultant brain atrophy  Memory, especially short term, most affected Language Characteristics of Alzheimer’s Disease:  Initially word-finding, off-topic comments, and comprehension difficulties  Later paraphasia and delayed word-finding  With more advanced, vocabulary and sentence production difficulties  In most advanced o Naming and syntactic errors o Minimal comprehension o Jargon, echolalia, or mutism Life Span Issues of Alzheimer’s:  Person usually unaware  Early memory loss, especially new information o Word-retrieval and higher language difficulties o Initiate little communication  Gradual vocabulary decrease, comprehension reduction, and pragmatic skills deterioration o Frequent repetitions and ritualized or high usage phrases  Nursing home o Meaningless language, echolalia or mutism o Motor functioning impaired Assessment for People with Alzheimer’s:  MRI may confirm early suspicions  SLP identifies changes in language functioning as disease progresses ▯ History and neurological  Particularly interested in memory deficits  Detail client’s strengths and weaknesses Intervention for Alzheimer’s:  Goal: Maintain client at highest level of performance and help others maximize client’s participation  Team effort  Target o Word memory with associational tasks o Auditory attending and comprehension o Verbal responding o Formation of sentences 3 Approaches of Intervention for Alzheimer’s:  Cognitive rehabilitation o Individualized goals (e.g., recalling name of family member) o Implement strategies based on goals  Cognitive training o Structured practice to improve specific cognitive functions (e.g., attention, memory)  Cognitive stimulation o Less direct, often in groups, general enhancement of cognitive and social functioning More intervention for Alzheimer’s:  Errorless learning o Memory intervention technique o Use cues / instructions to prevent / reduce mistakes o New neural pathways o Reduce cues with time (vanishing cues)  Spaced retrieval o Prompts to recall info occurs at spaced or delayed intervals 7. What are the major differences between aphasia, right hemisphere injury, TBI, and dementia? APHASIA = Without language, caused by localized brain damage RIGHT HEMISPHERE INJURY = Occurs in right cerebral brain hemisphere, affects pragmatics TBI = caused by blow/jolt to the head, affects Chapter 12: Audiology and Hearing Loss 1. What are the incidence and prevalence of hearing loss?  12% of U.S. population has hearing loss  Doubled since mid 1980’s  3 in 1,000 births results in child with hearing loss (most common birth defect)  1 in 1,000 births results in child with severe to profound hearing loss  83 in 1,000 children in U.S. has educationally significant hearing loss  278 million persons worldwide with more than mild loss in each ear  In developing countries, fewer than 1 in 40 who need hearing aid have one 2. Explain the difference between impairment, disability, and handicap with regards to hearing loss.  Impairment o WHO—loss of structure or function o Various impairments can occur from trauma, loss of sensory cells, or tumor  Disability o The functional CONSEQUENCE associated with a particular impairment o Ex: inability to understand speech o The disability may or may not be present  Handicap o Participation restriction—psychosocial consequence of the hearing loss o When you impairment causes you to not participate 3. What are some aspects of the deaf culture?  Culture—share a common background of language, traditions, mores, & values  Deaf Culture o common language: American Sign Language (ASL) o Rich history, traditions, folklore, & contribution to the arts 4. Where might an audiologist work?  Non-residential health care settings - >50%  Hospitals – 27%  Schools – 11%  Universities – 9%  Industry - <9% (work in manufacturing of ear pieces) 5. What is the difference between audibility and intelligibility? Audibility  The ability to detect the presence of a given sound Intelligibility  The ability to understand what is heard 6. How does sound travel to reach our ears and be perceived? Auditory Physiology: Sound impinges on TM à transmitted through ossicular chain to footplate of stapes à oval window à perilymph moves àTectorial membrane moves à endolymph moves à basilar membrane moves à hair cells on organ of Corti (mechanical forces transformed into electro-energy) à nerve endings are stimulated à CN VIII à auditory pathways à temporal lobe of brain 7. What are the main functions of the outer, middle, and inner ear? What are the following anatomical parts and where are they found in the ear (i.e., outer, middle, or inner ear)? Anatomy and Physiology of the Auditory System: Peripheral auditory system—damage can result in deficits in hearing sensitivity o Outer ear o Middle ear o Inner ear o Vestibulocochlear nerve (cranial nerve 8 or CN VIII) Central auditory system—damage can result in deficits related to the processing of sound o Auditory brainstem o Auditory cortex of the brain The Outer Ear: o Pinna o Flexible cartilage with ridges & depressions o Shape is natural resonator o Helps localization o External auditory meatus  Elliptical tube from pinna to tympanic membrane  Functions as a natural resonator o Acoustic energy The Tympanic Membrane:  Border between outer and middle ear  Thin, concave-shaped  Highly elastic  Vibrates in response to sound waves o Transfers acoustic energy to mechanical energy The Middle Ear:  Middle ear space/tympanic cavity  Eustachian tube connects middle ear to nasopharynx  Ossicular chain (smallest bones) ▯ Malleus—embedded in the tympanic membrane ▯ Incus—articulates with malleus and stapes ▯ Stapes—end of ossicular chain o footplate rests against the oval window o Converts mechanical energy to hydraulic energy o The smallest bone in human body The Inner Ear: o Two parts: Cochlea and vestibular system o Cochlea—very complex structure oProvides auditory input to the central nervous system  Hair cells—innervated at the base by auditory nerve fibers  Converts hydraulic energy to neuroelectrical impulses o Vestibular system—balance & spatial orientation Cochlea (the swirly part): o 2 labyrinths o Endolymph in the inside labyrinth o Basilar membrane o Floor of cochlea o Organ of Corti lies on basilar membrane o Contains hair cells responds to sound Tectorial membrane o Roof moved by perilymph o Transmits movements to endolymph Hair cells stimulated o Hydraulic Ø neuro -electrical energy o Stimulates nerve endings ▯ Reissner’s membrane  Moved by perilymph  Transmits movements to endolymphHair cells stimluated  Mechanical Ø electrical energy  Stimulates nerve endings Pinna: o Flexible cartilage with ridges & depressions o Shape is natural resonator o Helps localization o Outer ear External auditory meatus (canal): o Elliptical tube from pinna to tympanic membrane o Functions as a natural resonator o Outer ear Tympanic membrane:  Border between outer and middle ear  Thin, concave-shaped  Highly elastic  Vibrates in response to sound waves o Transfers acoustic energy to mechanical energy  Outer ear Ossicular chain (malleus, incus, stapes):  Malleus—embedded in the tympanic membrane  Incus—articulates with malleus and stapes  Stapes—end of ossicular chain o footplate rests against the oval window o Converts mechanical energy to hydraulic energy  The smallest bone in human body  Middle ear Eustachian tube:  connects middle ear to nasopharynx  middle ear Vestibular system:  balance & spatial orientation  inner ear Cochlea (hair cells): (the swirly part)  Very complex structure  Provides auditory input to the central nervous system o Hair cells—innervated at the base by auditory nerve fibers o Converts hydraulic energy to neuroelectrical impulses  Inner ear  2 labyrinths  Endolymph in the inside labyrinth  Basilar membrane o Floor of cochlea  Organ of Corti lies on basilar membrane o Contains hair cells responds to sound Tectorial membrane o Roof moved by perilymph o Transmits movements to endolymph Hair cells stimulated o Hydraulic Ø neuro -electrical energy o Stimulates nerve endings ▯ Reissner’s membrane o Moved by perilymph o Transmits movements to endolymphHair cells stimluated o Mechanical Ø electrical energy o Stimulates nerve endings 8. Describe the central auditory system: Central Auditory Nervous System:  Ascending & descending pathways  Nerve fibers from cochlea enter brainstem  Auditory information processed in temporal lobe  Some fibers ascend to the brain on same side  Vast majority cross and ascend to the opposite side  Left hemisphere—linguistic info processed  Right hemisphere—non-linguistic auditory info processed 9. What is the speech banana?  Describes area where the phonemes, or sounds of human speech, appear on an audiogram  Many other sounds fall outside of the speech banana  Audiologists are most concerned with the frequencies within the speech banana because a hearing loss in those frequencies can affect a child's ability to learn language. 10. What is hearing loss in terms of which ears, degree of loss and place of loss? Explain the differences between conductive, sensorineural, and mixed hearing loss. What is Hearing Loss?  Which ear/s? o Unilateral – one ear o Bilateral – both ears  Degree of loss o Mild ▯ Child: 20dB to 40 dB ▯ Adult: 25dB to 40 dB o Moderate o Moderately-Severe o Severe o Profound  Place of Loss o Conductive – outer or middle ear (temporary) o Sensorineural – inner ear or auditory nerve (permanent) o Mixed o Central Auditory Processing o Auditory Neuropathy Spectrum Disorder (ANSD)  Sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired (NIH, 2015) Types of Hearing Loss:  Conductive hearing loss o Malfunction, obstruction, or damage of the outer or middle ear o If you have to turn up the volume, you have conductive o Loss of sound intensity o Disorders of the outer ear—microtia, atresia, stenosis, and excess cerumen (ear wax) o Disorders of the middle ear perforation of TM, disarticulation of bones, Cholesteatoma, otosclerosis, and otitis media  Otitis media (STILL conductive) o Inflammation of mucous membrane in middle ear o >90% of US children by 7 years o Peak between 6 mos. and 2 years o Crucial time for speech, language and cognitive development  Results from Eustachian dysfunction o Lack of ventilation leading to reduced air pressure in middle ear compared with ear canal ; TM retracts into middle ear and secretion of fluid  Fluid filled middle ear rather than air filled  Treatment: medication (e.g., decongestants, antibiotics) myringotomy, pressure equalizing tubes  Sensorineural hearing loss o Absence, malformation, or damage to the inner ear  Most often problem with hair cells o Most often loss in high frequency o Loss of sound intensity and clarity o ***Impact depends on degree of loss, age of onset, when identified, and age of person when intervention began o Congenital—present at birth o Adventitious—sometime after birth: gradual or sudden o Prelingually (before 2) vs. postlingually (after 5)  Disorders of the inner ear (IE) (Sensorineural) o Aplasia: Malformation of IE during embryonic development o Genetic disorders: Usher syndrome (hearing and vision), Waardenburg syndrome (hearing & coloring of hair, skin & eyes) and Alport syndrome (hearing and kydney) o Illness or ototoxic exposure: maternal rubella, STD  Disorders of the inner ear (IE) (Sensorineural) o Viral infections: mumps, meningitis o Meniere’s disease: Fluctuating and progressive SN loss, tinnitus, vertigo, fullness in ear o Auditory Neuropathy spectrum disorders (ANSD): abnormal responses form the inner hair cells or auditory nerve fibers  From normal to profound loss  Difficulty understanding speech  Disorders of the inner ear (IE) (Sensorineural) ▯ Acoustic neuroma: tumor on acoustic nerve ▯ Noise-induced hearing loss: often avoidable o Temporary threshold shift (TTS) ex: front row at loud concert o Permanent threshold shift (PTS) o Time-intensity trade-off: 90 dB for 8 hours; for every 5 dB increase, half the time (check out Rockers Web site!) ▯ ***Presbycusis - Approx. 45% of adults between 48 and 92 yrs have some degree of hearing loss (progressive loss of hearing as you age) ▯  Mixed Hearing Loss ▯ Simultaneous presence of conductive and sensorineural loss ▯ Ex. Person has hearing loss due to noise exposure and impacted cerumen 11. What is the most common type of hearing loss? Low, mid, high frequency loss.  High frequency 12. Explain how disorders of the peripheral auditory system differ from those of the central auditory system.  In central auditory you can hear fine but can't process it  Auditory Neuropathy Spectrum Disorder 13. What are causes of conductive and sensorineural hearing losses?  Disorders of outer/middle ear such as otitis media, obstructions (conductive)  Absence, malformation, damage (sensorineural) 14. What is a conductive, sensorineural and **mixed** hearing loss?  Conductive = outer or middle ear (temporary)  Sensorineural = inner ear of auditory nerve (permanent)  Mixed = conductive + sensorineural combined o Simultaneous presence of conductive and sensorineural loss o Ex. Person has hearing loss due to noise exposure and impacted cerumen  15. Describe the characteristics of auditory processing disorders and central auditory processing disorders.  (Central) Auditory Processing disorders (C)APD  Inability of efficiently & effectively use and interpret auditory information  Associated with sound localization & lateralization  Auditory discrimination & temporal processing of speech  Understand in background noise or other acoustic conditions  Manifests in a variety of ways o Symptoms similar to language impairments, LD, ADHD, or autism  May be a result of: o delayed neuromaturation of the central auditory system o neurologic disorders o Diseases o Neurological insults o Genetic link o Auditory deprivation due to chronic otitis media  2-3% of children, males outnumber females  10-20% of older adults  Variety of behavioral characteristics o Easily distracted, difficulty comprehending rapid speech and/or speech in poor acoustic environments, difficulty localizing sounds, and many others  Comprehensive testing and assessment by an audiologist 16. What effects can hearing loss have on communication and psychosocial well-being of an individual?  Grief, anger, frustration, adjustment 17. What are the signs of hearing loss in adulthood?  Not hearing loved ones well  Miss out on conversations  Ask “what” often  Misunderstand  Withdrawn  Less involved 18. What is the difference between a hearing screening and an assessment?  Screening o Processed used to determine which individuals are LIKELY to have a hearing loss  Assessment o Comprehensive examination of the hearing mechanism 19. What is noised induced hearing loss (NIHL)?  NIHL: Noise induced hearing loss is the most common and the most preventable. o 1 in 5 teens o 30 million Americans exposed a. What are ways to reduce exposure to prevent NIHL? o Volume control: 60-60 rule (don’t listen to anything at more than 60% volume for more than 60 minutes) o Set output limits o Move earpiece to outside ear o Wear hearing protection in noisy environments o Noise cancelling headphones/earbuds o Stay away from Turbo Bass! b. What are the “4 P’s” of NIHL? o Noise-induced hearing loss is generally painless. o Noise-induced hearing loss is progressive over time. o Noise-induced hearing loss is typically permanent. o Noise-induced hearing loss is preventable c. What are the signs that “it might be too loud?” o You have to shout to be heard over the noise when your listener is arms-distance or 3ft away. o Speech around you sounds muffled or dull after leaving a noise area o You have pain or ringing on your ears (tinnitus) after exposure to noise. o Someone tells you that they like the song you are listening to under your headphones. 20. Identify the methods used in evaluating hearing in children. How do these compare with methods used with adults? Assessing Infants and Children:  Pediatric audiologists  Behavioral tests  Electroacoustic tests  Electrophysiological tests  Instruments used to assess progress relative to functional auditory development Assessing Adults:  Challenging adult populations  Adults with disabilities require frequent testing modifications  Non-organic hearing loss  Hearing loss does not exist  Geriatric clients 21. What are the goals of aural habilitation and rehabilitation? Aural Habilitation/Rehabilitation:  “Intervention aimed at minimizing & alleviating the communication difficulties associated with hearing loss”  Aural habilitation—intervention when hearing loss occurs at an early age  Aural rehabilitation—intervention when hearing loss occurs later in life  Evidence-based practice important  Overall goal: Improve functional communication 22. Explain the types of intervention considered when developing and individualized aural habilitation/rehabilitation plan. Amplification  Selection, fitting, & evaluation of amplification  Hearing aids  Components: microphone, amplifier, & receiver  Different styles/sizes  Most use digital signal processing  Programmed with a computer  Goal: make speech audible to the user, improve intelligibility  Hearing aids will not restore hearing to normal  Middle ear implant  Implanted in middle ear space  Amplifies sound “mechanically”  Bone anchored hearing aid (BAHA)  Bone vibrator coupled to conventional hearing aid  Vibration stimulates cochlea via bone conduction  Cochlear Implants  Neural prosthesis that bypasses damaged hair cells & directly stimulates auditory nerve with electrical energy  Severe-to-profound loss—little benefit from hearing aids  Components:  External—microphone, speech processor, & external transmitter  Internal—receiver-stimulator & electrode array  Implanted as early as 12 months  Benefit of implant varies significantly  From ability to have greater awareness of environment to understanding connected speech over the phone  Hearing Assistive Technology (HAT)  Used to help overcome hearing difficulties in a certain environment  FM system  Sound field amplification  Teletypewriter (TTY)  Auditory Training  Goal: Maximize residual hearing  **Neural plasticity  Stimulus complexity  Environmental sounds to complex connected discourse  Assess and train auditory perceptual skills  Auditory awareness  Auditory discrimination  Auditory identification  Auditory comprehension  Communication Strategy Training  Strategies to facilitate communication or repair communication breakdowns—more fluent conversations  Increase awareness of environmental barriers ▯ Ex. Background noise, poor lighting, & distance  Request appropriate modification ▯ Ex. Adjust lighting, ask speaker to slow down  Anticipate/predict what is likely to be said during conversation  Ask message to be rephrased  Gestures & writing  Communication Modality:  Spoken communication vs. manual communication o Factors:  residual hearing, language & cognitive abilities, manual dexterity, and personal (family) preference  Auditory-based approaches o Auditory-Verbal o Auditory-Oral  Visually based approaches o Manually Coded English (e.g., Signing Exact English) o American Sign Language (ASL) o Pidgin Signed English (PSE) (Contact signing) o Fingerspelling and Cued speech


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