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60 Cards in this Set
- Front
- Back
List of Communication Options
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ASL (bi-bi)
Auditory Verbal Cued Speech Auditory Oral Total Communication |
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Auditory Therapy
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Involves an attempt to assist a child or adult with a hearing loss in maximizing the use of whatever degree of residual hearing remains
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Components of a Communication Model
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Source or Speaker
Message Receiver Feedback Environment |
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Development of Auditory Skills
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Newborns possess a functional auditory system that is capable of perceiving auditory stimuli at 20 weeks gestation. Auditory processing skills continue to develop and refine following birth.
Rapid emergence of auditory skills is crucial for the development of speech processing skills and the emergence of speech and language. |
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Range of frequencies the human ear can perceive
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20-20,000Hz
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Range of intensity levels the human ear can process
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0dB SPL- 130dB SPL
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Average speech intensity when measured at a distance of 1 meter
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45dB HL
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Average shout
vs. Faint speech |
Average shout: 65 dB HL
Faint speech: about 25 dB HL |
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Spectrum of Speech Frequencies
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Overall spectrum of speech is composed of acoustical energy from approximately 50 to 10,000 Hz.
Greatest amount of speech energy occurs at frequencies below 1000Hz, attributed largely to the fundamental frequency of the adult human voice. |
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Formant
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Band of frequencies that are resonated, or boosted in energy, by the vocal tract
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Segmental Features
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features associated with individual speech sounds
(Manner, Voicing, Placement) |
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Suprasegmental Features
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features of speech that are superimposed on phonemes and words (think DIP)
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Duration of Speech Sounds
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Duration of individual speech sounds range from 30 to 300 msec
- vowels generally longer than consonants - overall rate of speech varies considerably from speaker to speaker |
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Sound Perception Components
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1. Detection- awareness of sound
2. Discrimination- same or different 3. Identification- label what was heard 4. Attention- focus on the message 5. Memory-retain verbal info., combine speech units to derive meaning 6. Closure- fill in the gaps 7. Comprehension- full understanding |
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"Noise"
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Within the speaker: poor syntax, poor articulation
Within the environment: abnormal lighting, competing visual stimulation, competing auditory stimulation Within the listener: poor listening skills, poor ATTENDING skills, lack of familiarity with the rules of the language |
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When considering auditory training for adults, two general objectives are relevant:
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1. Learning to maximize the use of auditory and other related cues available for the perception of speech.
2. Adjustment and orientation to facilitate the optimum use of amplification, cochlear implant or tactile device |
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Early Efforts in Auditory Training
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Raymond Carhart recommended that auditory training for adults should focus on re-educating a skill diminished as a consequence of hearing loss.
Training sessions be conducted in three commonly encountered situations: 1. Relatively intense background noise. 2. The presence of competing speech signal 3. Listening on the telephone |
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Candidacy
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Most common use of auditory-based therapy is for children with prelingual sensorineural hearing loss.
In recent times, with cochlear implant recipients, for both children and adults. |
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Assessment of Auditory Skills (Children)
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Includes:
1. Determining whether or not auditory therapy appears warranted. 2. Provides a basis for comparison with post-therapy performance, to assess how much improvement in auditory performance, particularly speech perception, has occurred. 3. Identification of specific areas of auditory perception to concentrate on future training. Young children- standardized tests but also informal testing and observation are highly relied upon. Older children- usually more formal, in depth assessment of overall speech perception abilities. |
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Commonly Used Tests (Children)
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Word Intelligibility by Picture Identification (WIPI)
Northwestern University Children’s Perception of Speech (NUCHIPS) Ling 6 Sounds Test Test of Auditory Comprehension (TAC) Glendonald Auditory Screening Procedure (GASP) Developmental Approach to Successful Listening (DASL) Early Speech Perception Test (ESP) Auditory Perception Test for the Hearing Impaired (APT-HI) |
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Assessment of Auditory Skills (Adults)
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Formal and informal tests of speech perception are available for use with adults.
Some tasks include: Monosyllabic word lists Perception of consonants Tests which employ sentence-like stimuli with speech babble (recording of several people talking at once) Ability to perceive connected discourse Introducing competing noise to a test situation Use of visual cues (bisensory-using hearing and vision together) to evaluate integrative skills |
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Developmental Approach to
Successful Listening |
(DASL II)
Highly structured, based on a hierarchy of listening skills Sound Awareness Phonetic Listening Auditory Comprehension |
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SKI-HI
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Home intervention treatment program for infants and families
Developmentally based auditory-training program Utilized in conjunction with speech and language stimulation, 4 phases and 11 general skills. (refer to pages 139-141 in text) |
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Speech Perception Instructional Curriculum and Evaluation (SPICE)
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Guide for clinicians in evaluating and developing auditory skills in children with severe to profound hearing loss.
Contains goals and objectives associated with 4 levels of speech perception: Sound detection Suprasegmentals Vowel and consonant perception Connected speech |
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Consonant Recognition Training
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-relies primarily on an analytic approach to facilitate improved speech production
-incorporates speechreading into a combined auditory-visual approach -allows for intense drill to occur for a select number of consonants during a relatively short therapy session |
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Communication Training and Therapy
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-common form of audiologic rehab emphasizing the role of communication strategies and pragmatics to facilitate successful communication
(see Tables 4.12 and 4.13 page 144 in text) Anticipatory Strategies (e.g.,minimize distance from speaker) Repair Strategies (e.g.,ask speaker to repeat all or part of a message) |
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Mission of the Auditory-Verbal Approach
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Help children who are deaf or hard of hearing to learn to use their listening potential to communicate through spoken language.
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Overview of Auditory-Verbal Option
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No one system, approach, or communication methodology to meet all the individual needs of the child and family.
When parents choose the A-V approach as their family’s way to manage a child’s hearing loss, they select a method that requires informed and active involvement. Like no time before in the history, the A-V approach is a viable option for most children with hearing loss. With advanced technology providing powerful hearing aids and cochlear implants, the majority of children with hearing loss should have access to usable hearing. |
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Listening (A-V Approach)
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The A-V approach focuses on LISTENING which leads to the natural development of speech and language.
With optimal access to sound, learning to listen and talk can begin immediately and can occur during all waking hours. |
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10 Principles of Auditory-Verbal Therapy
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1. Promote early diagnosis of hearing impairment in newborns, infants, toddlers, and children, followed by immediate audiologic management and Auditory-Verbal therapy.
2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation. 3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing spoken language without the use of sign language or emphasis on lipreading. 4. Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active participation in individualized Auditory-Verbal therapy. 5. Create environments that support listening for the acquisition of spoken language throughout the child’s daily activities. 6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child’s life. 7. Guide and coach parents to use natural developmental patterns of audition, speech and language, cognition, and communication. 8. Guide and coach parents to help their child self-monitor spoken language through listening. 9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the child and family. 10. Promote education in regular classrooms with typical hearing peers and with appropriate support services from early childhood onwards. |
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Parental Participation
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The A-V approach embraces the view that children learn language most easily when actively engaged
in relaxed, meaningful interaction with supportive parents and caregivers. Parents learn to: -Model techniques for stimulating speech, language, cognition and communication activities at home. -Plan strategies to integrate listening, speech, language, cognition and communication into daily routines and experiences. -Communicate as partners in the therapy process. -Inform the therapist of the child’s interests and abilities. -Interpret the meaning of the child’s early communication. -Develop appropriate behavior management techniques -Record and discuss progress. -Understand short and long-term goals. -Develop confidence in parent-child interactions. -Make informed decisions. -Advocate on behalf of their child. |
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Auditory-Verbal Therapy Sessions
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Cover 4 Areas:
1. Audition 2. Language 3. Speech 4. Cognition Generally one to one and a half hours long. Parent or caregiver ALWAYS present. Therapist models the planned activity and parents carry forth. Activities planned so easily duplicated at home. Weekly targets explained to parents. Parents report weekly home outcomes. |
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Auditory-Verbal Techniques
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Acoustic highlighting (whispering, singing, emphasizing elements in syntax and/or segmental or suprasegmental information)
Repeating exactly what the child says Asking the child, “What did you hear?” Moving closer to the microphone Rewording, providing alternatives Waiting/pausing for responses Auditory sandwich Hand cue |
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Variables Affecting Child’s Progress
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Age of diagnosis
Etiology of hearing loss Degree of hearing loss Effectiveness of amplification device Effectiveness of audiological management Hearing potential of child Health of the child Emotional state of the child Level of participation of the family Skills of the therapist Skills of the parents Child’s intelligence Child’s learning style |
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language
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Language is a term to describe a system of symbols used as a social tool for the exchange of information.
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morphology
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Study of minimal units of language that are meaningful (-s for plural, -ed for past tense)
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phonology
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Study of sound systems used in languages
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syntax
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Rules of how words are arranged in sentences.
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semantics
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Study of word meanings and word relations.
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pragmatics
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Functional use of language
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Factors Affecting Language Acquisition
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Other handicapping conditions
Predictors Cultural and linguistic diversity Early intervention Cochlear implants |
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Other Handicapping Conditions
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Nearly 40% of children with hearing loss have other challenges
10.0% learning disabilities 9.1% mental retardation 6.6% attention deficit 4.5% visual impairment 3.2% cerebral palsy 2.0% emotional disturbance 13.3% other |
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Predictors
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Predictors of early expressive language for children with hearing loss
-Age of identification(before/after 6 mo.) -Child’s cognitive status -Presence or absence of one or more additional disabilities Language abilities cannot be predicted by the degree of hearing loss alone. |
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Cultural and Linguistic Diversity
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Estimated by 2050, the proportion of individuals from other linguistic and cultural backgrounds will increase by 50% of the total U.S. population
(Caeser & Williams, 2002) While performing assessments on children with hearing loss whose families have other linguistic backgrounds, it is essential to have interpreters present if the clinician is not proficient in the language as supported by the IDEA. Family members should not serve as interpreters- risk of bias. |
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Early Intervention
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Early identified children without other handicapping conditions show age-appropriate language abilities and continue to maintain age-appropriate language abilities. (Yoshinaga- Itano et al., 1998a)
Caution: Some research only looks at vocabulary. Kindergartners who are i.d. early have conversational skills comparable to normal hearing peers. |
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Cochlear Implant Use
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1990 FDA approved multichannel cochlear implant use in children
Nicholas & Geers, 2007- implantation at ages 12-16 mo. more likely to achieve age-appropriate language at 4.5 years than if implanted after 24 months. Dettman et al., 2007; Holt & Svirsky, 2008; Lesinski-Schiedat et al., 2004- higher language skills if implanted before 1 year than those implanted between 1 and 2 years of age. Geers, Nicholas, and Sedey (2003) evaluated children aged 8 and 9 years; implanted by 5 ½ years Findings for strongest predictors for language ability: Greater non-verbal intelligence Smaller family size Higher socioeconomic status Female gender |
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Comparing OC and TC Progrms
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Better speech production for those in oral communication (OC) programs
Early advantage in receptive communication for those in total communication programs (TC) (Connor et al., 2000) Children from OC programs have fewer communication breakdowns (Tye-Murray 2003) Keep in mind, much variability in TC programs |
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Language of Children with Hearing Loss
SYNTAX |
Shorter and simpler sentences
Overuse of certain sentence patterns Infrequent use of adverbs, conjunctions Non-English word order Incorrect usage of irregular verb tense |
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Language of Children with Hearing Loss
SEMANTICS |
Reduced expressive and receptive vocabulary
Limited understanding of metaphors, idioms, and other figurative language Difficulty with multiple meanings of words |
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Language of Children with Hearing Loss
PRAGMATICS |
Restricted range of communicative intents (requests, conversational devices)
Lack of knowledge regarding conversational conventions, such as changing the subject or closing conversations Limited knowledge and use of communication repair strategies |
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Knowledge of Schema in Preschool Children
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While experiencing typical sequences of events and communication (dinner, bedtime) the child stores and remembers a body of knowledge, called schema, about the events.
Some children with hearing loss have limited schemata. (lack of ease in eavesdropping or if family uses sign language, members typically do not always sign as they speak to one another) |
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Early Vocabulary in Preschool Children
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Classic study by Yoshinaga- Itano, et al. (1998)
Showed advantages in language learning for children whose hearing loss is identified by 6 months of age. Interesting finding… Early-identified children with lower cognitive levels achieved the same language levels as late- identified children with higher cognitive skills. |
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Preliteracy and Literacy Issues
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Low reading and writing proficiency skills for children who are deaf or hard of hearing have been related to limited oral language skills.
Important precursor to reading is phonological awareness. (ability to recognize that words are made up of phonemes, syllables, onsets (h, c, l) and rimes- h(ot), c(ot), l(ot). A rime is the part of a syllable which consists of its vowel and any consonant sounds that come after it. Speechreading does not provide enough information for phonological awareness. Some parents of very young children who are deaf or hard of hearing may unintentionally overemphasize spoken language in the early years and overlook literacy. |
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Language Assessment
and Cautions |
Communication checklists
Formal Language tests Communication/language sample analyses Most assessment tools are standardized for use with children with normal hearing. Cautions: Testing language, not listening ability. If signing, many signs are iconic. (Show me your nose.) Formal tests may not provide a true measure of linguistic skills in everyday conversations, which provides linguistic/situational cues. |
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Communication and Language Management
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Create or participate in experiences that allow for the child to learn about a wide range of events and reasons to communicate about them.
Don’t drill, facilitate! Adults should be responsive and contingent when facilitating language. -Bathe the child in language -Give the child an opportunity to communicate, following his/her lead. |
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Tips in developing conversational skills:
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Recasting: Correctly reword a child’s comments without changing meaning (“Doggy runned fast.” “Yes, the doggy ran fast.”)
Experiential learning events to develop schema. (If child has a dental appt., first read a book about going to the dentist, talk about what is going to happen, go to the appt., then later have the child retell the experience to someone.) Sabotoging: Provides opportunities for children to protest, comment, or request. (pretend one can’t open a bottle of bubbles, set the table without any silverware, etc.) |
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Early Vocalizations (Hearing Children)
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Crying and vegetative sounds (burps, coughs, sneezes)
Cooing and laughing Reduplicated babbling (dadadada) Variegated babbling (badabada) with sentence-like intonations Speech sound combinations called vocables that consistently represent meaning. (ba-ba for bottle) First words around 12 mo. of age |
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Early Vocalizatons of Infants with Hearing Loss
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Also coo, squeal, growl and babble
Produce fewer consonant-like sounds from 6-10 months; some rarely babble or stop babbling at this age Produce greater proportion of velar-back consonants at 12-15 months (without early intervention/amplification) |
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Speech Intelligibility
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Intelligibility affects daily conversation and sadly, affects perceptions of a speaker’s cognitive ability and personality. (Most, Weisel, & Matezky, 1998).
Some who are deaf choose not to speak even if they have some intelligible speech. Intelligibility may be directly related to degree of hearing loss, but much variability. Better indicators include aided audiometric thresholds and speech perception abilities. |
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Speech Characteristics
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Children with mild to moderately severe losses (up to 70 dB) generally have intelligible speech with some articulation and phonological errors.
Children with severe-profound losses (>70dB) are more variable in speech intelligibility. Range from 0-100% Possible errors in: vowel and diphthong production consonants respiration (shallow breaths) resonance (hyponasality or hypernasality) phonation (breathy voice quality with inadequate vocal fold adduction, abnormally high fundamental voice frequency, excessive voice intensity and vocal fold resistance. suprasegmental speech characteristics |