aural rehab final
visemes
-"sounds" (like phonemes) that look the same on the lips -for consonants these are phonemes with same place of articulation (voicing and/or manner differences)- very easy to tell difference between phonemes with different places and very hard to tell difference between phonemes that have the same place
when can reversing roles in therapy be useful? (ex: ok, this time you make up the sentence and I see if I can get it)
-Adds interest and fun for client -Provides client a sense of control -Especially useful with the acoustic hoop in auditory training (to reduce feelings of frustration)
language and literacy in deaf individuals: pragmatics
-Communication breakdowns may lead to maladaptive strategies (bluffing, dominating conversation, etc) -Turn-taking, topic maintenance difficulties -Lack of eavesdropping/incidental learning can affect pragmatics—children learn adult behaviors through eavesdropping -Children who grow up with ASL may have different pragmatic/cultural style (might use touch, gestures, facial expressions more)
speech perception assessment
-Comparing your client's speech perception across different conditions can help you understand their communication style and abilities, to shape appropriate and functional goals for therapy. Some possibilities: Auditory-only (aided, unaided) Visual-only Auditory-visual (aided, unaided) In quiet and noise -considerations: noisy backgrounds, connected speech (sentence testing), speechreading skills, performance with their FM system, etc
language and literacy in deaf individuals: content (semantics)
-Concrete, restricted vocabulary -Restricted use and understanding of idioms -Partly due to lack of exposure ("eavesdropping" aka incidental learning- adults talk with each other in a way that they wouldn't talk directly to children, children overhearing this is important for their learning of World knowledge, idioms, adult ways of relating to others, humor, etc.)
hierarchies of difficulty in speechreading consonants
-Consonants produced with front articulators are easiest to see. -Visual discrimination between consonants is easier when place of articulation differs greatly. -Initial consonant discriminations are easier than final or medial discriminations (e.g. /Tim/ vs /Kim/ (initial) is easier than /hit/ vs /hick/ (final) and /butter/ vs. /pucker/ (medial))
how can synthetic training relate to speech and language training
-Discourse tracking as well as other synthetic exercises provide a useful platform for speech and language training. -Target phonemes or language structures can be intentionally inserted into the response stimuli by clinician -Client gets practice producing target words or connected speech -Clinician uses the opportunities to make corrections in client's production
common effects of elevated hearing on conversation
-Disrupted turn-taking from missing auditory ("it's your turn") cues (ex might miss inflection for a question and think it was just a statement) -person with elevated hearing might either dominate the conversation or talk too little -Inappropriate topic shifts as a result of misunderstanding -"Communication breakdowns" disrupt flow A communication breakdown is any misunderstanding on the part of either partner (person with typical hearing could be confused about sudden topic shifts, or person with elevated hearing could be confused from mishearing something) -person with elevated hearing might pause longer to process the information result of this is that: -Individual with elevated hearing may be left out of conversations (especially fast-moving group conversations) -Choice of topic may be simplified or limited (by either partner) for fear of communication breakdowns -longer/less familiar words are harder to catch so people might simplify it for person with elevated hearing
maladaptive communication strategies common with hearing loss
-Dominating conversations to avoid communication breakdowns (if person is dominating conversation they don't have to listen so there are less communication breakdowns, but this also means they aren't really connecting with the other person so its a more subtle form of social isolation, can seem either friendly or aggressive) -Withdrawing from conversation (spacing out, or leaving the room, social isolation, depression, health problems, etc can come into play here) -bluffing (pretending to understand, HoH people often become masters at bluffing, sometimes without even realizing they are doing it, reasons include frustration after asking someone to repeat a lot of times, awkwardness/embarrassment, its easier socially/emotionally, think that maybe with more context later you'll catch up and get it)
how to do analytic training in speechreading therapy
-Explain concept of visemes -Although it may seem easy to you, it is a new way of thinking to your client. -Often it's best to avoid terminology. -Bilabial consonant viseme group, the easiest to see, is a good place to start. /b/ /p/ /m/ -In other words, give a mini-phonetics class to your client. ---Explain voicing and manner differences using /b/ /p/ and /m/ as a starting point. -Demonstrations, client & clinician productions -Client watches their production in a mirror -Tactile reinforcement (i.e. hand on throat) may be helpful -Use a piece of paper and/or condensation on mirror to demonstrate voicing differences -Introduce a second group e.g. the labiodentals /f/ /v/ -NOW: Practice differentiating stimuli in different viseme groups in visual-only condition (never in same viseme group! unless to illustrate that visual-only differentiation is impossible) -Continue through all viseme groups. This will require time and patience. -Remember: not all clients need (or have patience for) thorough analytic training, if client doesn't like analytic training then move on
communication strategies therapy
-Extent: can range from one 1-hour session to 12 weeks (etc.) as needed -Format: individual or group -Frequent communication partners should be included whenever possible! -can be a part of a session, can be a major goal that you work on over multiple sessions, etc depending on the client and how quickly you get through the strategies/how the client responds to them -group therapy can be helpful if people have had same problems and can troubleshoot together -Help your client and family or frequent communication partner recognize aspects of their communication that are positive, negative -Encourage the use of Clear Speech by the client and client's frequent communication partners -Use therapy sessions to teach and practice positive communication styles and strategies
hierarchy of synthetic tasks (from easier to harder)
-Fill-in-the-blank phrases -"Gap" sentences -Topic related sentences -Discourse tracking -Low context sentences ALSO: -Addition of background noise to any task -Sabotage: try to trick them or say something incorrectly/make it hard for them on purpose to help them practice strategies for communication breakdowns
what are ways to present stimuli for speechreading in the visual only condition (no auditory information)
-For profoundly deaf: HA or processor turned off -For hard of hearing: mouth the words silently (but this is hard to do without over exaggerating the movements) -Or use recorded stimuli (DVD etc.) with no sound -Not a problem on Zoom! just mute microphone
assessment of language in deaf individuals
-Formal (for hearing or for hearing impaired) and informal (evaluation of spoken language sample) -Catalog forms (e.g., negation, sentence structures) and vocabulary in client's repertoire: expressive and receptive -Language errors or limitations can contribute significantly to intelligibility problems!
assessment of speech production in deaf individuals
-Formal tests normed on typically hearing children e.g., Goldman Fristoe Test of Articulation -Formal tests designed for children with elevated hearing include: Phonetic Level and Phonological Level Speech Evaluation (Ling), CID Inventory (Moog), SPINE (SPeech Intelligibility Evaluation) from CID Use a combination of tasks in addition to formal tests. Evaluation on-line or record for later evaluation. For example: -Imitate words or short phrases -Read a passage at the appropriate reading level (assuming the client can read) -Relate a story from a set of pictures -Spontaneous speech sample during play or conversation -Relating a story from a set of pictures -Gathering a spontaneous speech sample during play or conversation (some of these can be used to evaluate language as well as speech) how to evaluate a recorded sample: -Phonetically transcribe results & catalog errors -Or have naïve or familiar others listen to the recording and: -Rate intelligibility* on a scale (intelligibility refers to how well the individual is understood by OTHERS) -Write what they hear -Phonetically transcribe what they hear
synthetic speechreading training
-Give your client practice with connected speech. -Encourage use of redundant cues to fill in the gaps -ideas: can have a picture sitting there and talk about the picture and then they point to the things in the picture that you're talking about -can have a few pictures and then they have to decide which picture you're talking about
speech production in infancy and childhood
-Hearing and auditory feedback is required for monitoring speech production -Subtle articulatory movements within the vocal tract are not visible: hard to imitate (and not interesting) without auditory feedback -Games of hearing children include word games, rhymes etc. The articulators—particularly the tongue--develop agility from playing these games -Deaf babies imitate what they see, also with a lack of auditory feedback they might not be as motivated to work on speech or be able to perceive it acoustically/visually
homophenes
-Homophenous words or phrases look alike on the lips They may be spelled (and sound) very differently (ex. can't and hand, doubt and noun) -Between 47-56% of words in English are homophenous
tools/methods of assessment for communication strategies
-Informal, unstructured conversation with patient alone, or with patient and significant other, or with a small group of HoH individuals -Evaluate "on-line" or record for later evaluation. -Quantify M.L.T. (mean length of turn): Count number of words or amount of time for both conversational partners, divided by number of turns Near equal M.L.T. for both partners is optimal -Count number of communication breakdowns -Evaluate/quantify client's use of repair strategies (this term will be defined and explored) -Ask outside observers to rate client's communication effectiveness -Follow a structured communication assessment such as TOPICON1 or Quest?AR2 -Administer a questionnaire and use it to begin a dialogue and give you a more specific picture of what someone is struggling with (like using the phone) -questionnaire examples for adults: HHIA (Hearing Handicap Inventory for Adults) and Self Assessment of Communication (SAC), "Significant Other" forms are available for both -questionnaire examples for children: ELF (Early Listening Function)—infants and toddlers and CHILD (Children's Home Inventory of Listening Difficulties)—age 3 to 12, has sections for caregiver and child to fill out, so if their responses don't match you can use it as a point of discussion
assessment of speech, language and literacy in deaf individuals
-Many formal assessment tools used for normal hearing children can also be used for hard of hearing and deaf children (and adults) -Comparing to age norms may be less important than carefully establishing baseline and goals: catalog the client's repertoire and/or errors and establish achievable goals, following speech and language hierarchies
ideas for communication strategies therapy activities
-Modeling -Role playing -Use synthetic training activities for facilitative and repair strategies practice (upcoming lecture) -Real-world practice: Have client keep a daily log of real-life communication breakdowns and successes, then discuss during subsequent therapy sessions
what are advantages for presenting recorded speechreading stimuli
-More consistent for baseline & post-Tx measures -Client can work at own pace, independently, possibly at home -Cost benefit for client after initial purchase -live on a recorded zoom call might be the most ideal scenario- can mute it so you can say it in a natural way and have it be personable/adjust in the moment, but recorded so they can go back to it and practice at home later
what are advantages for presenting speechreading stimuli live
-More personal -Therapist can adjust level of difficulty on the spot -Therapist can more easily monitor client's interest, degree of frustration -Helpful for counseling aspect of AR
language and literacy in deaf individuals: form (syntax)
-Overuse of simple subject-verb-object (SVO) structure -Limited use of complex sentences, adverbs, prepositions -Unusual word order -Omission of articles (a, an, the) -Omission of plural markers (/s/ /z/) -Tense problems: omission of -ed, mixing of present, past, future -some Deaf individuals have ASL as first language, which might affect their spoken English (with the omission of articles, plural markers, etc)
suprasegmentals in deaf speakers
-Pauses: due to the need for air or effortful articulation, rather than to add information (as in Clear Speech) -Rate: often slower, more effortful than typical-hearing speakers -Stress: Poor or no use of stress may be from unfamiliarity, because it is mostly an auditory event (not visual) -Reduced or poor co-articulation: careful placement of articulators learned from speech therapy
what factors make real life speechreading difficult
-Rapidity of speech -Homophenous words and phrases -Coarticulation effects—same phoneme may look different depending on surrounding phonemes -Talker effects—visual differences in pronunciation of same phonemes (e.g. /l/--how do you produce this phoneme?) -Stress is important for the message, but it is often not visual
respiration and voice in deaf speakers
-Respiration for non-speech activities may be normal, however: Inefficient airflow for speech--wasting of air -Poor biomechanical resistance at larynx, i.e., Inadequate vocal fold adduction often results in "breathy" quality (and speaking in a breathy voice for a while makes you run out of air fast) -Poor biomechanical resistance at supra-laryngeal articulators, e.g., explosive consonants -Unintended, extraneous emissions of air/sound -Vocal pitch: failure to maintain even pitch (pitch might go up and down), abnormally high pitch (might be consistently abnormally high) Vocal intensity: too loud or soft, inability to adjust level for different noise conditions (library vs. ball game)
SLP scope of practice for speech, language and literacy
-SLPs are trained to assess and treat children (including hearing impaired children) for speech & language production. -Some SLPs have training in literacy as well. -Special experience and training are recommended for working with Deaf children
therapy for language in deaf individuals
-Schema: planned learning events, real or imaginary, helps you set up new vocabulary, ex a trip to the zoo, can make an experience books after the fact -Experience books--with pictures and items gathered from events in the child's life -Common routines and sabotage -Strong, early emphasis on storytelling, reading, awareness of written language. (Yes, hearing parents should read to their Deaf children!, reading with children shows them that reading is a positive thing and gets them interested in it)
using context to manipulate hierarchies of difficulty
-Sometimes we purposefully reduce contextual redundancy in order to encourage client to rely more on bottom-up auditory or visual skills. -High context: The cowboy rode away on his horse. -Low context: The woman likes stories about football.
how can you combine synthetic training with communication strategies training
-Synthetic Training exercises will naturally promote communication breakdowns -Get a double whammy with these therapy exercises by encouraging appropriate use of Repair strategies
expressive repair communication strategies
-Talker recognizes there has been a misperception, often by puzzled look from communication partner -Repeats message verbatim or with new information (more slowly, with gesture, rephrased, written) -these strategies are for communication partners, but also important for client to know in case they're talking to other people with elevated hearing levels
vowels in deaf speech
-Tendency to move jaw to produce different vowel sounds (as opposed to hearing people using jaw and tongue), because jaw movement is more visible than tongue -Tongue body does not move forward and back as much as typical hearing (Due to lack of agility, not weakness-Remember children's games, sound play) -As a result: vowels may be neutralized, diphthongized (due to over movement of the jaw) -Nasalization: hyper- and/or hypo- nasal (Velopharyngeal port is not a visible articulator; accurate velopharyngeal port manipulation is difficult without auditory feedback, when vowels are produced in isolation the velopharyngeal port is closed, but this changes with coarticulation) -Prolongation: In "deaf speech," vowel sounds are prolonged, i.e., vowel to consonant ratio (duration) is higher than in typical hearing speakers
patient (self) oriented facilitative strategies
-Use counseling techniques to help your client develop self confidence and physical well-being -confidence/ people who are willing to put themselves out there to communicate is going to make communication easier help clients advocate for themselves, educate other people about their hearing so they're included -Relaxation & breathing exercises can be helpful- if all your energy is going to frustration it gets exhausting to listen -Prepare for communication situations: World knowledge (stay up to date with current events since a lot of people talk about current events so being prepared allows you to have a smaller neighborhood of words that might be discussed), Have paper and pencil or other written system ready to use in case of communication breakdown (and help them understand it's ok to ask people to write things down) A.R. therapy -Learn to "advertise" (notify new partners of hearing-encourage patients to discuss and role-play their fears and possible outcomes of this strategy)
how do you use clear speech
-Use prosody, intonation and stress to emphasize key words -Use meaningful pauses to clarify your message (gives people more processing time) -Speak slowly and clearly -Articulate all consonants and vowels as precisely as possible without over-exaggerating articulation -Make word boundaries clear. For example say: "I am going to class" rather than: "I'm goindaclass" -Also—make sure your communication partner is looking at you when you speak
redundant cues
-Visual and auditory cues (when both vision and audition are available to your client, even in a limited way) -Body language, facial expressions -Knowledge of language structure provides syntactic cues -Knowledge of vocabulary provides semantic cues -World knowledge and knowledge of subject provide situational cues
what communication strategies should families and educators of Deaf and HoH children work on with the children
-Work with children on perspective-taking/putting yourself in other peoples' shoes (theory of mind) -Provide explicit training for understanding social relationships -Social etiquette training should start in preschool—how to behave with other people, how to make friends -With elementary and middle school children: explore/analyze videos and real-life situations -Discuss hidden social messages
communication strategies training that is important for families of Deaf and HoH children
-anticipate typical maladaptive strategies and nip them in the bud (ex leaving dinner table to go read- this means child is struggling at dinner table, help them work around it) -Provide opportunities for friendships (play dates, other social activities) (ex: "you've talked about Fred a couple times, do you want me to invite him over"- good because you can control communication environment (make sure theres not background noise, only one other kid)) -Be sure the child is never left out of conversations! -Deaf and HoH role models are critically important—both age peers and adults
what are cloze phrases
-fill in the blank phrases- can be auditory-only, visual only, or auditory plus visual -Only for clients who can read! -Client has the printed sentences -Clinician produces entire sentence -Client must fill in the missing word(s) written or verbally -can vary the difficulty by giving more choices, less choices, or fully fill in the blank (open set), or can vary it based on hierarchies of difficulty for the condition (auditory vs visual), can also make it easier by choosing an expected word vs an unexpected word (unexpected words reduce redundancy and increases reliance on bottom-up processing in the condition being targeted (i.e. auditory or visual).
is it possible to become 100% accurate at speechreading
-no: no one can speechread with 100% accuracy no matter how long you practice it (although you can get very good) -so many things can affect speechreading- lots of talker effects such as speed of the talker, stress that they put on words, how well the enunciate words, how much their lips move, also on the client's side things like working memory have an effect, processing speed (see better results in younger individuals than older individuals as a group), see better results in people who were born with elevated hearing, whether the client knows the context of the conversation, how far away the client is from the speaker
receptive repair communication strategies
-rephrase- same meaning, different wording: ex "are you going to the store today" vs "are you going to Wegmans today" -elaborate- add more info -request topic- getting to the whole thing: are we talking about the gym or Jim your friend, more of a topic confirmation than a whole message confirmation, ex I didn't quite hear that, were you talking about going to the gym to workout? or Jim Smith? or "I missed that completely, what were you talking about?" -confirm- rephrase what the person said back to them/making sure you have the same info as they do, more of a whole message confirmation -nonspecific (what? huh? etc, most common but least effective since usually person will just repeat the same exact words at the same speed, but it can be useful, as it is short and may disrupt flow less than others All repair strategy types are valid, however: Always using the same phrase can get on frequent communication partner's nerves! (ex always asking someone to rephrase can get exhausting for them) Help clients practice using all types of receptive repair strategies.
discourse tracking
-synthetic training activity -Clinician reads aloud from material that is appropriate for client's age and interests, one phrase or sentence at a time -Client must repeat verbatim -Progress is tracked using: percent correct and/or time spent to accomplish the repetition accurately
how is synthetic training in background noise applicable to real life
-tend to use multiperson babble or one other person talking, and high levels of background noise, to make it most applicable to the real world -Client can practice with the noisy condition OR: Client can practice the facilitative strategy of requesting partner to turn down the noise source or move to a quieter location
what is sabotage in therapy in general
-to purposefully set up a difficult condition for the client, to encourage use of a desired communicative act or strategy -for example, Clinician sets up the therapy room with poor lighting or in a noisy background. Or clinician speaks very fast, covers mouth with hand, turns face away, etc. -can use this to prompt client to use facilitative strategies and repair strategies
what to do when a client needs help with a synthetic exercise
-you can repeat the stimulus more slowly, or prompt them to use redundant cues: -Knowledge of language structure (syntax)- do we need a noun, verb, or adjective in this part of the sentence -Knowledge of vocabulary (semantics) (ex where are places people go in the summer) -World knowledge and knowledge of subject (encourage client to watch TV, read newspapers, be aware of what is going on in the world) -Redundant cues help all of us in our day-to-day communication. -We can help our clients by explicitly teaching and encouraging the use of redundant cues as part of their synthetic training -in assessments, usually don't repeat things multiple times but in therapy if they're struggling with a word/sentence you can repeat it a second time
who would be a good candidate for communication strategies training and counseling
All clients with elevated hearing who use spoken language will likely benefit from communication strategies training and/or counseling at some point during their therapy
what type of speechreading therapy should you do for a client with below average speechreading scores?
Analytic and synthetic speechreading training
what type of therapy might be done to help with a client's intelligibility of their speech
Articulation (speech production) Language (structure, semantics) both
what can synthetic training exercises be used for
Auditory training Speechreading training Communication strategies training Speech and Language therapy
analytic training
Bottom Up. At the phoneme, syllable, single word level
how to you assess speechreading skills in adults
C.U.N.Y. sentences; Utley Sentence Test; Denver Quick Test; commercially available recorded material
who is a good candidate for speechreading therapy
Children: mild to profound hearing loss (depending on educational method) Adults: sudden or gradual hearing loss, moderate to profound hearing loss, early or late onset The relative emphasis on speechreading and the way it is presented should depend on client's age, abilities and interests probably won't use it as a therapy tool for people with mild hearing loss as an adult bc they are hearing enough of the auditory signals that they don't need to rely on it as much
consonants in deaf speech
Consonants produced with front articulators are easiest to produce in terms of place but not manner -Voicing errors -Nasalization and other manner errors Plosives are often explosive, contributing to wasting of air Back consonants /g/k/h/ hard to see consonants with (the front articulators are easiest to see place wise) /r/ often distorted (hard to learn /r/ without any auditory feedback) s/ often produced as a stop /t/ or omitted entirely- /s/ is often not visible when marking plural or possessive; important for language as well as speech
reading in deaf children
Deaf children attain "average 4th grade reading level" Why? -Limited phonological awareness -Less early exposure to books & reading -Limited eavesdropping: educed world knowledge and limited exposure to idioms -Over-emphasis on spoken language, less time for reading and writing instruction -Improvement with CI? Evidence is promising -but: Deaf children in Deaf families have higher reading levels than Deaf children in hearing families
therapy for speech and language with deaf individuals
Educational method/setting greatly affects how speech and language therapy is conducted for Deaf/deaf children: -Total Communication -Bilingual-Bicultural -Cued Speech -Auditory-Verbal (Listening and Spoken Language) We will focus on auditory/oral for our discussion of speech and language production In most auditory/oral school-based programs, sounds are associated with letters, displayed on charts, constantly available, bombarded and reinforced in order to support phonemic awareness and to tie spoken to written language You may notice this is similar to typical classroom settings -Ling 6 sounds can also be used for production practice (/ɑ/ /u/ /i/ /s/ /ʃ/ /m/) -Breath control exercises are fundamental -Articulation practice with breath control e.g., "bee bee bee..." then "bee boo bee boo" (think of babbling hierarchy and the need for agility of the articulators) -Production of child's name is important (child needs to be able to say their name and have other people understand it) -High but realistic expectations for "correct" productions (e.g. you may have to accept /s/ for /z/) (realistic expectations allow you to have time to work on other things) Speech as a visual phenomenon-- Link your therapy with speechreading training—e.g. manner and voicing of phonemes (helpful for working on speech production when there is little or no hearing) Speech as a physical phenomenon-- Encourage touch, tactile, and kinesthetic feedback, allowing client to feel your productions as well as his/her own e.g., -Voiced vs. voiceless consonants—hand on throat -Nasals—finger on side of nose -Production of /p/ vs. /b/ --feel the difference of the breathiness on hand -Production of stops vs. continuants, e.g. /t/ vs. /s/ feel the difference of the breath on hand Use computer speech programs (e.g., Visi-pitch, Praat) to practice/learn about: Pitch control Phrasing/stress in connected speech Intensity control (or use SL meter) (or the Ninja game created by the STEPP lab to train velopharyngeal port manipulation)
what is the historical context of speechreading
Historically: Lip-reading was an essential part of AR and aural habilitation With improvements in technology, there was less emphasis on lip-reading More recently: It is getting attention in recent literature There are new therapy materials for speechreading, including computer programs It is important to understand the role of speechreading for hearing impaired clients
resonance in deaf speakers
Hypernasality and Hyponasality- Both are common in the speech of deaf and hard of hearing
vowels vs consonants in deaf speech
In "deaf speech" vowels are judged more intelligible than consonants. Why? -Easier to produce—no vocal tract restrictions (don't have to place articulators particularly) -Easier to hear--vowels are more powerful than consonants, so deaf speakers may have more opportunity to monitor their own productions -More acceptance of different vowel productions by listeners e.g. regional & foreign accents (accents tend to affect vowels more than consonants so listeners are more used to hearing different vowels)
what are visual distinctions between vowels used in speechreading
Lip rounding (rounded vs. spread) Jaw height (high vs. low)
WATCH mnemonic
MEMORIZE THIS W—Watch the talker's mouth. A—Ask for clarification. T—Talk about your hearing loss. C—Change the situation. H—Healthcare knowledge (or: Helpful gestures) (healthcare knowledge- knowing what's going on bc elderly people often have lots of health issues and like to talk about them (or just knowledge in general, know what's going on in your world) helpful gestures- ex gesturing for person to keep going/elaborate)
language and literacy in deaf individuals: writing
Same deficits as form & content of spoken language are common in written language
what type of speechreading therapy should you do for a client with average or above average speechreading scores?
Speechreading training (especially synthetic training) may be part of the plan, but focus should be on other aspects of A.R.
effect of neighborhood density on speed of word recognition
Studies have shown that words from sparser neighborhoods are recognized more quickly than words from denser neighborhoods
how do you assess speechreading skills in children
Test of Child Speechreading (ToCS); Gist Test; Children's Audiovisual Enhancement Test (CAVET)
McGurk effect
The effect illustrates: Audiovisual integration Redundant cues in speech perception Top-Down processing
what is the goal of communication strategies training
To compensate for the effects of elevated hearing on interpersonal communication
ways to manipulate hierarchy of difficulty with synthetic training
To increase difficulty: -speak at faster pace -use longer sentences ("expansion") -choose more sophisticated topics -use poor S/N ratio (introduce background noise)
synthetic training
Top Down. At the connected speech level.
hierarchies of difficulty in speechreading vowels
Visual discrimination between vowels is easiest when lip spreading/rounding is greatly different: /i/ (very spread) /u/ (very rounded) As with auditory-only discrimination, memorizing the vowel chart can help with hierarchy of difficulty for vowels contrasts in visual-only (see slide 31 of speechreading lecture 1!)
facilitative communication strategies
anticipate and manage the environment, self, partner
partner oriented facilitative communication strategies
ask communication partners to use clear speech (with instructions like slow down a little bit, come in the room so they can see them, enunciate more, don't chew gum while talking)
how do you assess the need for communication strategies training
assess conversational fluency & style, including the use (or lack of use) of communication strategies, how many times does communication break down in a conversation/how often are breakdowns happening
how do you assess the need for counseling
assess impact of elevated hearing on individual's activities & participation, given the context of their life (note WHO ICF language) -do people decide not to do things because they're worried about communication breakdown- ex person is a rower and doesn't want to lose hearing aids so they don't wear them on the water, but are missing cues from the coxin, so they decide not to row anymore
is clear speech auditory or visual
both auditory and visual!
how much does clear speech improve reception
by 11-34%
how does clear speech relate to speechreading training
clear speech can minimize the effects of factors that make real life speechreading difficult, therefore clear speech trainingfor client's frequent communication partners is as important as speechreading training for the client! (Remember: Clear Speech is auditory and visual.)
should you include auditory signal in speechreading assessment and therapy?
completely silent for assessment, for therapy either talk at a softer volume or whisper if you want to give them some auditory information, or can also do completely silent
how do redundant cues relate to speechreading (visual only) vs auditory only training
different place is hard to hear auditorily, but different place is easy to see visually, so when we have both visual and auditory information together it's easier to distinguish, and context also helps in real life
what are the 3 types of facilitative (anticipatory) communicative strategies
environment oriented, patient oriented, partner oriented
who uses speechreading cues
even typical hearers use speechreading cues especially in noisy environments
gap sentences
example of synthetic training exercise- client has a bunch of blanks with a couple words filled in, clinician produces the entire sentence and client must fill in the blanks, gap sentences are harder than Fill-in-the blank because less information is provided
what are the 2 main types of communication strategies
facilitative and repair
audiovisual integration
information from the auditory and the visual signals combine to form a "unified percept"
repair communication strategies
recover from a breakdown once it occurs
areas of difference in speech production of deaf speakers (and HoH children and those with Cochlear Implants to a lesser extent)
respiration and voice, resonance, suprasegmentals, vowels, consonants
what is the basis for all speech production problems in deaf speakers
respiration and voice- these affect everything else
speechreading vs lipreading
same thing! speechreading is more common in academia and research. Emphasizes importance of visual and auditory, facial expression, context cues, as well as looking at lips, lipreading is an older term and is more familiar to the general public than "speechreading" (which makes some people think of reading speeches)
topic related sentences
synthetic training exercise- Clinician and client agree on a topic of interest -Clinician presents a phrase or sentence about the agreed-upon topic in the condition or manner appropriate for the current goals *e.g. V-only, A-V with background noise, etc.) -Client has no printed information, but knows the topic and the vocab since they are familiar with the topic
what are some rules of conversation we tacitly agree to
turn taking, not dominating the conversation or talking too little, sharing a topic, developing the topic together (ex responding appropriately), usually centered around shared interest/information
environment oriented facilitative communication strategies
visual: -Lighting should be bright but comfortable -Light source should illuminate the face of communication partner of HoH person -Viewing angle—direct, not angle view -Distance to partner 3-6 ft optimal auditory: -Reduce background noise: move away from noise source, turn off noise source, or choose the quietest place in a room -Reverberation—reduce, eliminate or move to a different location -HoH person sit facing wall in a restaurant or noisy place (because its hard to hear sound behind you and hearing aids are designed to amplify sounds in front of you and dampen sounds behind you so theres less auditory (and visual) distractions) -Distance to partner 3-6 ft. optimal (because of inverse square law) physical comfort: Verbal -communication for the HoH requires more effort than for a typical-hearing person! -Find a comfortable place that will not add stress -being too hot, too crowded, uncomfortable clothes, etc makes it harder to listen Poor environment also reduces a typical-hearing person's ability to understand partner. This adds to communication breakdowns and frustration for both partners
are vowels or consonants harder to differentiate in visual only condition
vowels are harder to differentiate in visual only condition- some talkers move their mouths very little
auditory and visual neighborhoods
words that both sound and look similar- this usually. has a more sparse neighborhood density than the auditory neighborhood or visual neighborhood independently
visual neighborhoods
words that look similar on the lips
auditory neighborhoods
words that sound similar to a word
