SHS 451 Midterm Study Guide exam with complete solutions 2024_2025.docx, Exams of Nursing

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SHS 451 Midterm Study Guide exam with

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Auditory rehabilitation vs. Auditory habilitation - ANSWER-auditory rehabilitation is typically used for adults who need to regain skills that have already been developed auditory habilitation is typically used for children who need to gain skills that have not been developed yet What is pure tone average? How do you figure it? - ANSWER-the average of hearing sensitivity at 500, 1000, and 2000 Hz threshold at 500 Hz + threshold at 1000 Hz + threshold at 2000 Hz / 3 = PTA When do PTAs and SRTs agree vs. disagree? - ANSWER-PTAs and SRTs agree when they are within 10 dB of one another they disagree if they are greater than 10 dB apart What is the International Classification of Function (ICF) and what can it be used for? - ANSWER-The ICF is a classification system that considers the consequences of health-related conditions, such as hearing loss, within the context of a patient's environment and circumstances the focus is not on fixing the hearing loss, but rather how hearing difficulties can affect the patient in everyday life, and how hearing-related disability might be alleviated

it can be used for aural rehabilitation to help patients with hearing loss learn how to deal with their hearing loss and still function how this wish to What are the 4 main components of aural rehabilitation? Give examples of each - ANSWER-Sensory management

• wearing hearing aids, cochlear implants, assistive technology systems, or assistive listening devices Counseling
• counseling related to results of hearing test
• information related to hearing aid options and processes
• personal adjustment counseling (enhances a patient's acceptance of hearing loss and communication difficulties) Instruction
• how to insert/remove the devices
• how to change the batteries
• how to clean and care for the devices
• how to change the volume control and/or listening programs
• how to utilize hearing protection appropriately Perceptual training
• communication strategies training
• speechreading training
• auditory training
• speech therapy Most Comfortable Loudness Level (MCL) - ANSWER-the intensity level at which sound is most comfortable for a listener audiologist presents running speech to patient and asks them to rate the loudness by assigning it to a number on the Cox loudness scale stimuli starts just above SRT and increases until a rating of 4 (comfortable) is reached Uncomfortable Loudness Level (UCL) - ANSWER-the level at which sound becomes uncomfortably loud for a listener ensures that a patient will never experience a sound amplified through the hearing aids that is uncomfortably or painfully loud

protocol is same as MCL, but increases volume until patient rates sound as 7 (uncomfortably loud) dynamic range - ANSWER-the difference in decibels between a person's threshold for just being able to detect speech and the person's threshold for uncomfortable listening will often influence the selection and programming of an individual's listening device and sometimes the design of the patient's auditory training program what is the difference between homophones and visemes? - ANSWER- Homophones are WORDS that look identical on the mouth, while visemes are groups of speech SOUNDS that appear identical on the lips ex homophene: perch & merge ex viseme: /p b m/ What is the McGurk Effect and what does it illustrate? - ANSWER-The McGurk Effect showed that if a viewer watches a visual signal saying "da" while hearing the auditory signal saying "ba", they will hear "da" This illustrates audiovisual integration what is SNR and how do you figure it? - ANSWER-signal-to-noise ratio indicates the difference in the sound level of the signal vs. the sound level of the noise sound level of the signal - sound level of the noise = SNR Ex: signal = 40 dB; noise = 30 dB --> 40 dB - 30 dB advantages of phoneme stimuli in speech tests - ANSWER-performance is unaffected by a patient's vocabulary level no need to familiarize patient with test stimuli before use a feature analysis can often be performed disadvantages of phoneme stimuli in speech tests - ANSWER-poor face validity

advantages of word stimuli in speech tests - ANSWER-higher face validity than nonsense syllables easy to score performance is not affected by ability to use context or knowledge of linguistic structure disadvantages of word stimuli in speech tests - ANSWER-don't reflect real world listening situations may not be appropriate for some who have limited vocabulary advantages of phrase and sentence stimuli in speech tests - ANSWER-high face validity and reflect real-world situations

• prosodic cues
• contextual information
• coarticulation disadvantages of phrase and sentence stimuli in speech tests - ANSWER- linguistic knowledge topic familiarity memory may negatively impact What speech stimuli is used in speech recognition testing (SRT)? - ANSWER- spondee words (baseball, hotdog) What speech stimuli is used in word recognition score (WRS) test? - ANSWER- monosyllabic words what speech stimuli is used in most comfortable loudness level (MCL) test? - ANSWER-running speech (phrases/sentences) what stimuli is used in uncomfortable loudness level (UCL) test? - ANSWER-can be done using speech, but typically done with pure tones or narrowband noise (yield more frequency specific information)

What is the difference between SRT and WRS? - ANSWER-SRT uses spondee words to find the softest level that a patient can repeat words back correctly 50% of the time WRS uses monosyllabic word lists presented at a comfortable listening volume (40 dB above SRT threshold) to find the percentage of words that a patient can repeat back at a comfortable listening level What are personal sound amplification products (PSAPs)? How do they differ from HAs? - ANSWER-PSAPs are electronic products worn in the ear that amplify sounds, and they are typically used by consumers who cannot afford hearing aids (they're inexpensive) or who do not have ready access to haring health care They differ from HAs because they do not address other aspects of hearing loss, such as the configuration of the loss or distortion They also are not intended to compensate for hearing loss and are not subject to FDA approval because they are not considered to be medical devices also cannot be marketed as a treatment for hearing loss what are the 4 main parts of every hearing aid? - ANSWER-microphone amplifier receiver battery function of microphone - ANSWER-Converts the auditory signal into an electrical signal function of amplifier - ANSWER-increases the intensity of sound function of receiver - ANSWER-converts electrical energy into acoustic energy function of battery - ANSWER-provides electrical power what is compression? what are its purposes? - ANSWER-Compression is a nonlinear form of amplifier gain used to determine and limit output gain as a function of input gain

One purpose is to limit the maximum output of the hearing aid, so that sound is never so loud as to cause discomfort to the user A second purpose is to provide a range of sounds to the user within the person's dynamic range A third purpose is to provide a varying amount of gain (amplification) of the speech signal as a function of the input level (soft sounds typically amplified more than moderately loud sounds) what are the differences between top-down and bottom-up processing? - ANSWER-top-down processing

• influenced by expectations and prior knowledge
• a way that advanced cognition affects perception of sensory inputs
• typically used for adults bottom-up processing
• influenced primarily from input from the auditory periphery
• minimal cognitive processing in terms of expectations or prior knowledge
• typically used for kids example of when top-down processing is more heavily relied upon - ANSWER- whole song approach for music perception training examples of when bottom-up processing is more heavily relied upon - ANSWER- musical feature approach for music perception training phoneme-based training Familiar sounds audiogram - ANSWER-speech banana = 20-50 dB at 250 Hz, 35- dB at 1000 Hz, and 20-30 at 8000 Hz sounds above speech banana = /f s th/, /k/, and /p h g/ sounds in speech banana = /z y/ (top), /ch/ (top), /j m d b/ (middle), /sh/ (middle), /a r/ (middle), /n ng ee i u/ (bottom) what variables are predictive of speech reading ability? - ANSWER-cognitive skills (good spatial working memory and fast processing speed predicted better lipreading scores) age (young better than old)

individuals with congenital hearing loss (they lipread better than than individuals born with normal hearing) viseme sound sets - ANSWER-/p b m/ /f v/ /u ð/ /ʃ, ʒ, dʒ, tʃ/ (some research does not include dʒ and tʃ) /w r/ /l/ /t, d, s, z, n, i, g, j/ (other research does not include k, g, and j) /h/ Examples of homophenous word pairs - ANSWER-rise-rice perch-merge marry-bury mat-man bind-mite aunt-hand van-fat pass-ban down-stout how do you calculate auditory enhancement (speech reading enhancement)? - ANSWER-AV - V Ex: V score = 50% AV score = 75% difference score: 75% - 50% = 25% enhancement what are the different types of communication strategies? - ANSWER- instructional strategies message-tailoring strategies constructive strategies adaptive strategies maladaptive strategies

anticipatory strategies disregard utterance bluffing Instructional strategies - ANSWER-listener asks the talker to change the delivery of the message in one way or another, usually with a simple request message-tailoring strategies - ANSWER-changes in how the message is delivered to optimize the chances the message will be understood by the listener Ex: ask to state a question in such a way to give a closed set of potential responses constructive strategies - ANSWER-involve setting the environment up so that there is the best possible chance at successful communication adaptive strategies - ANSWER-focus on how to counteract negative influences that can have an effect on the patient's understanding/reception of the message include teaching a patient how to reduce anxieties or other negative emotions they may experience Ex: deep breathing or relaxation techniques maladaptive strategies - ANSWER-inappropriate behavioral mechanisms for coping with difficulties caused by hearing loss and a conversation Ex: socially withdrawing to avoid difficult situations or embarrassment anticipatory strategies - ANSWER-steps a person takes when they anticipate a particular interaction to prepare for that interaction Ex: review employee names and terminology related to job before interview bluffing - ANSWER-pretending to understand an utterance and behaving in a way that suggests that understanding occurred, even if little or none of the message was recognized

person may appear insensitive, uninterested, and inattentive receptive repair strategies - ANSWER-used when recipient with HL does not understand talker expressive repair strategies - ANSWER-used when person with HL produces an unintelligible utterance specific repair strategies - ANSWER-requires something specific of the communication partner, such as "did you say ball or doll?" non-specific repair strategy - ANSWER-letting the partner know that something was missed by saying "huh?" or "what?" what does tonotopic organization of the cochlea mean? How are frequencies coded in the cochlea? - ANSWER-tonotopic organization of the cochlea means that there is sensitivity to different frequencies based on the are of the cochlea the base of the cochlea (first part) is more sensitive to high frequency information the apex of the cochlea (end) is more sensitive to low frequency information advantages and disadvantages of live voice for speech testing - ANSWER-may be advantageous for older patients who might need longer to respond and may respond better to a real live voice disadvantages:

• more variability in live voice, so more variables can affect the results, including voice frequency, intonation, speech rate, articulation and clarity, and also possible physical characteristics of the audiologist What are the main parts of a comprehensive hearing test? - ANSWER-Hearing screening Pure-tone audiometry Speech audiometry purpose of obtaining an audiogram and how the results are reported - ANSWER-It provides a quantitative assessment of an individual's ability to detect sounds (determines the softest sound level at which the tones can be detected)

Results are plotted on an audiogram chart, with sound level and frequency purpose of speech audiometry - ANSWER-- determines need for amplification

• to compare performance with a listening aid to performance without an aid and to build patient confidence
• to compare different listening devices
• to demonstrate to patients that their ability to recognize speech is diminished
• to obtain information that might elucidate environmental listening issues
• to assess performance longitudinally
• to determine need for auditory training
• to determine placement within a training curriculum
• to determine if expected benefit has been achieved how results for speech audiometry are reported - ANSWER-SRT: level at which patient can repeat 50% of words correctly is reported as SRT in dB HL WRS: percent words repeated verbatim (correctly) purpose of hearing screening - ANSWER-to separate individuals into two groups:
• those who are likely to have a hearing loss
• those who are unlikely to have a hearing loss how hearing screening results are reported - ANSWER-pass or fail advantages of recorded speech testing - ANSWER-more easily compared to normative data individual talker characteristics do not confound the results eustachian tube - ANSWER-connects the middle ear to the back of the throat allows for any fluid or edema in the middle ear space to drain out so that it doesn't just sit in the ear and become infected equalizes pressure in the middle ear space semicircular canals - ANSWER-helps body to maintain proper balance

cochlea - ANSWER-snail-shaped and fluid-filled structure that contains the sensory (hair) cells, which are responsible for responding to sound and transmitting it to the auditory nerve outer ear consists of: - ANSWER-pinna and ear canal middle ear consists of: - ANSWER-cavity behind the tympanic membrane that houses the ossicles (malleus, incus, stapes) that are responsible for mechanically conducting sound waves to the inner ear eustachian tube inner ear - ANSWER-cavity next to middle ear that consists of the cochlea and semicircular canals conductive hearing loss - ANSWER-problem in the outer or middle ear loss in volume; clarity remains can often be reversed with medical and/or surgical intervention examples of conductive hearing loss - ANSWER-cerumen buildup foreign object in ear canal atresia/microtia otosclerosis eardrum damage/hole disarticulation of bones of middle ear fluid buildup in middle ear infection of fluid in middle ear (acute otitis media) cholesteatoma sensorineural hearing loss - ANSWER-damage to inner ear

loss in volume; loss in clarity examples of SNHL - ANSWER-presbycusis ototoxic medications noise-induced HL head trauma genetic causes maternal viral infections postnatal infections (measles & meningitis) mixed hearing loss - ANSWER-conductive and sensorineural hearing loss example of mixed hearing loss - ANSWER-presbycusis & cerumen build-up What is CAPD? - ANSWER-difficulty in differentiating, recognizing, and understanding sounds that is not due to either hearing loss or intellectual impairment What are the common features of CAPD? - ANSWER-decreased temporal resolution decreased binaural processing decreased auditory attention (ability of individual to attend to auditory signal - selective, divided, sustained) Main types of auditory training - ANSWER-phoneme-based training word-based training sentence-based training cognitive skill-based training

main research support phoneme-based training - ANSWER-learning to discriminate phonemes in nonsense syllables is akin to acquiring the "building blocks" of language, and this learning will generalize to recognizing larger speech units such as words and sentences (e.g., Moore, Rosenberg, & Coleman,

phoneme-based training - ANSWER-may present nonsense syllables in vowel- consonant-vowel context (aba vs. ata), and/or in CV or VC context (ba vs. ab), or may present real words in a static context, such as vowels in an h-d context word-based training - ANSWER-emphasizes meaningful speech units student might identify which of a member of possible word choices occurred main research supporting word-based training - ANSWER-Humes, Burk, Strauser, and Kinney (2009) taught students to recognize the 600 most frequently used words of the English language, as these words represent about 80-90% of the words used in the course of everyday conversation sentence-based training - ANSWER-presents sentences at training stimuli both top-down and bottom-up processing main research supporting sentence-based training - ANSWER-Computer-Assisted Speech Perception Sentence training program (CasperSent) (Boothroyd, 2008) -- each sentence in a training exercise pertains to one of 12 topics, such as food or work. Student listens to sentence and then self-scores the sentence by clicking on the words heard correctly once the orthographic version of the sentence appears on the computer screen cognitive skill-based training - ANSWER-uses cognition, which includes the mental processes that are used for perceiving, remembering, and thinking main research supporting cognitive skill-based training - ANSWER-research showing interactions exist between the effects of peripheral hearing loss and cognitive functions, such as working memory and selective attention (e.g., Pichora-Fuller & Levitt, 2012; Pichora-Fuller & Souza, 2003; Wingfield & Tun, 2001).

Target Word exercise of the LACE program is a training activity designed to develop auditory working memory (Sweetow & Sabes, 2006) Competing Speaker exercise of LACE requires students to focus on either a man's, a woman's, or a child's voice while ignoring a competing voice in the background (selective attention) define plasticity - ANSWER-the brain's ability to change as a result of experience, behavior, environment, or changes resulting from sensory deprivation or stimulation how does plasticity relate to hearing loss? - ANSWER-Acquired hearing loss may cause functional changes in the central auditory system, changes that can affect speech perception Receipt of a hearing aid or cochlear implant may lead to secondary brain plasticity, and lead to secondary changes in speech perception Neuronal changes may occur in the central auditory system as a result of auditory training what is the Lexical Neighborhood Test (LNT)? Why was it developed? - ANSWER- The lexical neighborhood test is composed of biyllabic or spondee words that belong to either a dense or sparse lexical neighborhood and patient is asked to identify what the words are It was developed for children with cochlear impacts (because of principles of acoustic lexical neighborhoods) acoustic lexical neighborhood - ANSWER-comprises a set of words that are acoustically similar and have approximately the same frequency of occurrence what is grounding? - ANSWER-a conversational phenomenon in which communication partners establish a body of information as shared or common for an ongoing conversational exchange TELEGRAM - ANSWER-T - Telephone E - Employment L - Legal issues E - Entertainment G - Group communication

R - Recreation A - Alarms M - Members of the family (are you having difficulty in these areas) telegram graph (high vs. low) - ANSWER-high on graph: no difficulty low on graph: great difficulty